Roger T Johnson, PAC
Individual provider Active NPI Family Medicine Physician · Pineville, WV
NPI 1316038607 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1316038607
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 122 (WV)
- Practice address
- Main St
Family Healthcare Assoc Inc
Pineville, WV 24874 - Phone
- (304) 732-6735
- Fax
- (304) 732-9161
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122 | WV | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 122 | WV | Yes |
Addresses
Primary practice location
Main St
Family Healthcare Assoc Inc
Pineville, WV 24874
Mailing address
PO Box 1650
Family Healthcare Assoc Inc
Pineville, WV 24874
Phone (304) 732-6735
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810000499 | Medicaid | WV |
Other providers in Pineville, WV
- Rita Grace Fortney
- Greenbrier Valley Physical Therapy LLC
- Jenny Marie Hatfield
- Charles E Hill Jr.
- Natasha D Huff
- Jo Ann Jones
- Phillip Just Sr.
- Kari Justice
- Jonathan L Karper
- Kelli M Karper
All providers in Pineville, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.