Wayne Clair Johnson

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Practice address

3115 N Govt Way
Suite #7
Coeur D Alene, ID 83815-3790

Phone

(208) 762-0797

Fax

(208) 762-0791

NPI assigned

Nov 13, 2006

Last updated

Jan 24, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake City Shoe Repair

  • Durable Medical Equipment & Medical Supplies
  • Coeur d'Alene, ID
  • NPI 1346629029
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1083785760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 N GOVERNMENT WAY",
            "address_2": "SUITE #7",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83815",
            "telephone_number": "208-762-0797",
            "fax_number": "208-762-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 N GOVT WAY",
            "address_2": "SUITE #7",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838153790",
            "telephone_number": "208-762-0797",
            "fax_number": "208-762-0791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WAYNE",
        "middle_name": "CLAIR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8053443",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryjayne Mabrey Johnson, ARNP
• Robert John Johnson, O.D.
• Simone Johnson, LMSW
• Tyler W Johnson, DO
• Vallenthia Ann Johnson, LMSW
• Wendy E Johnson, DPT
• Rosalie Nadine Johnston, LCPC
• Jonathan S King MD PC
• Kristina Marie Jones-Tarr, LMSW
• Brooke Jones

• Durable Medical Equipment & Medical Supplies in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Durable Medical Equipment & Medical Supplies in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.