Organization
MARY DIANE JOHNSON TMD OUTLET
Active
Organization
MARY DIANE JOHNSON TMD OUTLET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY D JOHNSON (OWNER/ABC CERTIFIED FITTER (REM0094)
(417) 588-3404
Entity
Organization
Contact information
Practice address
702 S MONROE, LEBANON, MO 65536-3570
(417) 588-3404
(417) 588-3404
Mailing address
702 S MONROE, LEBANON, MO 65536-3570
(417) 588-3404
(417) 588-3404
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174584
BLUE CROSS/BLUE SHIELD
MO
Enumeration date
08/29/2006
Last updated
06/16/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up