Provider Demographics
NPI:1952514994
Name:JOHNSTON, CASEY
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-0170
Mailing Address - Country:US
Mailing Address - Phone:605-882-2630
Mailing Address - Fax:605-882-0447
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-2630
Practice Address - Fax:605-882-0447
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5000207X00000X
SD7724207X00000X
MN51596207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00925881OtherRAILROAD MEDICARE
SDS104301Medicare PIN
MN200002968Medicare PIN