Provider Demographics
NPI:1548256530
Name:NEWTON H JOHNSON
Entity type:Organization
Organization Name:NEWTON H JOHNSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEWTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-470-8818
Mailing Address - Street 1:80 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8538
Mailing Address - Country:US
Mailing Address - Phone:952-470-8818
Mailing Address - Fax:952-470-6936
Practice Address - Street 1:80 FLORENCE DR
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-8538
Practice Address - Country:US
Practice Address - Phone:952-470-8818
Practice Address - Fax:952-470-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590828Medicaid
NE10024965300Medicaid
MN5711339Medicaid
WI41695700Medicaid
MN7G837NEOtherBCBS MN
NH30762422Medicaid
MN5711339Medicaid
WI41695700Medicaid