Provider Demographics
NPI:1427793371
Name:TIMOTHY S. JOHNSTON, M.D. PC
Entity type:Organization
Organization Name:TIMOTHY S. JOHNSTON, M.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-349-8459
Mailing Address - Street 1:3349 G ST STE F
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-349-8459
Mailing Address - Fax:
Practice Address - Street 1:3180 COLLINS DR STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3156
Practice Address - Country:US
Practice Address - Phone:209-259-4301
Practice Address - Fax:209-354-4932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY S. JOHNSTON MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-04
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528097847Medicaid