| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 08/09/2023 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Medicare PECOS PAC ID | 6406205772 |
|---|---|
| Medicare Enrollment ID | O20231212001881 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396428157 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Charles C Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902906464 PECOS PAC ID: 7416845656 Enrollment ID: I20110302000510 |
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