Johnson, Shad Carl
Johnson, Shad Carl is an individual health care provider with primary practice located at 1151 Hospital Way Bldg A , Pocatello ID 83201-2763. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Johnson, Shad Carl can be contacted via phone (208) 232-6616.Contact Information
Primary practice address
1151 Hospital Way Bldg A
Pocatello ID 83201-2763
Phone: (208) 232-6616
Fax: (208) 232-6618
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA-629 | Idaho |
Profile Details
| NPI number | 1114028354 |
|---|---|
| LBN Legal business name | Johnson, Shad Carl |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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