Charles C Johnson Do Pllc | |
3141 Beaumont Centre Cir Ste 103 Lexington KY 40513-1934 | |
(859) 523-0058 | |
Not Available |
Full Name | Charles C Johnson Do Pllc |
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Speciality | Family Medicine |
Location | 3141 Beaumont Centre Cir Ste 103, Lexington, Kentucky |
Authorized Official Name and Position | Charles Johnson (PHYSICIAN / OWNER) |
Authorized Official Contact | 8598061598 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Charles C Johnson Do Pllc 3141 Beaumont Centre Cir Ste 103 Lexington KY 40513-1934 Ph: (859) 523-0058 | Charles C Johnson Do Pllc 3141 Beaumont Centre Cir Ste 103 Lexington KY 40513-1934 Ph: (859) 523-0058 |
NPI Number | 1396428157 |
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Provider Enumeration Date | 08/09/2023 |
Last Update Date | 09/25/2023 |
Medicare PECOS PAC ID | 6406205772 |
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Medicare Enrollment ID | O20231212001881 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396428157 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Charles C Johnson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902906464 PECOS PAC ID: 7416845656 Enrollment ID: I20110302000510 |
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