Mary Diane Johnson Tmd Outlet

LBN: Mary Diane Johnson Tmd Outlet
Mary Diane Johnson Tmd Outlet is an health care organization with primary practice located at 702 S Monroe , Lebanon MO 65536-3570. The organization recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotic Fitter, which is considered as the primary health care specialty. Mary Diane Johnson Tmd Outlet can be contacted via phone (417) 588-3404, or through Johnson, Mary D via phone (417) 588-3404.

Contact Information

Primary practice address
702 S Monroe Lebanon MO 65536-3570
Phone: (417) 588-3404
Fax: (417) 588-3404
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Mary D
Phone: (417) 588-3404

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotic Fitter 225000000X

Profile Details

NPI number 1649389388
LBN Legal business name Mary Diane Johnson Tmd Outlet
DBA Doing business as
Authorized official Johnson, Mary D
Entity Organization
Organization subpart 1 No
Enumeration date Aug 29th, 2006
Last updated Jun 16th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649389388 NPPES
Missouri Other 174584 BLUE CROSS/BLUE SHIELD

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