NPIMap

Organization Active NPI

Glen E Johnson MD PC

  • Psychiatry Physician
  • West Valley City, UT
National Provider Identifier
1336443373
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
154764-1205 Issued in UT
Legal business name
GLEN E JOHNSON MD PC
Practice address
3940 W 4100 S
West Valley City, UT 84120-5450
Phone
(801) 966-3700
Fax
(801) 966-9421
NPI assigned
Jan 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Glen E Johnson, MD
Title
Owner
Phone
(801) 966-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 154764-1205 UT Primary

Addresses

Primary practice location

3940 W 4100 S
West Valley City, UT 84120-5450

Mailing address

555 E 4500 S Ste C150
Salt Lake City, UT 84107-4507
Phone (801) 288-0747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110201000553 UT Part B Supplier - Clinic/Group Practice 1052590437 Practice locations: West Valley City, UT

National Provider Directory

National Provider Directory

Locations

3940 W 4100 S
West Valley City, UT 84120
Phone (801) 712-0571

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1336443373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E 4500 S STE C150",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841074507",
            "telephone_number": "801-288-0747",
            "fax_number": "801-288-0761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 W 4100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841205450",
            "telephone_number": "801-966-3700",
            "fax_number": "801-966-9421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN E JOHNSON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-966-3700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "154764-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Valley City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.