# JOHNSON CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609898600
- **Authorized official:** MS. BONNIE E MATTERN (ADMINISTRATOR)
- **Authorized official phone:** (701) 776-5235

## Contact information

- **Practice address:** 800 3RD AVENUE SOUTHWEST, RUGBY, ND 58368
- **Practice address phone:** (701) 776-5235
- **Practice address fax:** (701) 776-5297
- **Mailing address:** 800 3RD AVENUE SOUTHWEST, RUGBY, ND 58368
- **Mailing address phone:** (701) 776-5235
- **Mailing address fax:** (701) 776-5297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 11/23/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10152 | — | ND |