Basic Information
| Provider Information | |||||||||
| NPI: | 1609997121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5800 FOXRIDGE DR | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132613153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20333 W 151ST ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137914291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 04-35584 | KS | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 2012009153 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200877220A | 05 | KS | MEDICAID | P01094625 | 01 | KS | RR MEDICARE | OTHER | P01119931 | 01 | MO | RR MEDICARE | OTHER | 200877220B | 05 | KS | MEDICAID | P01115725 | 01 | KS | RR MEDICARE | OTHER |