Provider Demographics
NPI:1225564826
Name:MARK ROLFE JOHNSON MD., P.C.
Entity type:Organization
Organization Name:MARK ROLFE JOHNSON MD., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-631-8210
Mailing Address - Street 1:1899 E SIESTA DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6241
Mailing Address - Country:US
Mailing Address - Phone:801-631-8210
Mailing Address - Fax:801-446-1474
Practice Address - Street 1:1899 E SIESTA DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84093-6241
Practice Address - Country:US
Practice Address - Phone:801-631-8210
Practice Address - Fax:801-446-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184901-1205310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility