Provider Demographics
NPI:1124348644
Name:DR CASEY D. JOHNSTON MD PC
Entity type:Organization
Organization Name:DR CASEY D. JOHNSTON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-882-2630
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-0170
Mailing Address - Country:US
Mailing Address - Phone:605-882-2630
Mailing Address - Fax:605-882-0447
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-2630
Practice Address - Fax:605-882-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDDR3580OtherRAILROAD MEDICARE
MNC05661Medicare PIN
SDS104300Medicare PIN