Organization
M COLE JOHNSON, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAYBEN COLE JOHNSON D.O (OWNER)
(208) 733-1112
Entity
Organization
Contact information
Practice address
526 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5050
(208) 733-1112
(208) 732-1212
Mailing address
526 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5050
(208) 733-1112
(208) 732-1212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O278
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010137639
BLUESHIELD
ID
01
—
S3788
BLUECROSS
ID
Enumeration date
06/06/2007
Last updated
08/22/2020
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