Organization
JOHNSON CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONNIE E MATTERN (ADMINISTRATOR)
(701) 776-5235
Entity
Organization
Contact information
Practice address
800 3RD AVENUE SOUTHWEST, RUGBY, ND 58368
(701) 776-5235
(701) 776-5297
Mailing address
800 3RD AVENUE SOUTHWEST, RUGBY, ND 58368
(701) 776-5235
(701) 776-5297
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10152
—
ND
Enumeration date
07/25/2006
Last updated
11/23/2007
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