Active NPI
Randy Lee Johnson
- Durable Medical Equipment & Medical Supplies
- Dundee, FL
National Provider Identifier
1508035189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 1312770
- Practice address
- 117 E Main St
Dundee, FL 33838-4219 - Phone
- (863) 223-2007
- Fax
- (863) 223-1879
- NPI assigned
- Feb 27, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 1312770 | FL | Primary |
Addresses
Primary practice location
117 E Main St
Dundee, FL 33838-4219
Mailing address
117 E Main St
Dundee, FL 33838-4219
Phone (863) 223-2007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1312770 | FL | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1508035189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 E MAIN ST",
"city": "DUNDEE",
"state": "FL",
"postal_code": "338384219",
"telephone_number": "863-223-2007",
"fax_number": "863-223-1879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 E MAIN ST",
"city": "DUNDEE",
"state": "FL",
"postal_code": "338384219",
"telephone_number": "863-223-2007",
"fax_number": "863-223-1879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RANDY",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-27",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "FL",
"license": "1312770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dundee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.