Mary Diane Johnson TMD Outlet

Primary specialty

Orthotic FitterTaxonomy code 225000000X

Legal business name

MARY DIANE JOHNSON TMD OUTLET

Practice address

702 S Monroe
Lebanon, MO 65536-3570

Phone

(417) 588-3404

Fax

(417) 588-3404

NPI assigned

Aug 29, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mary D Johnson

Title

Owner/Abc Certified Fitter (Rem0094

Phone

(417) 588-3404

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1649389388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S MONROE",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363570",
            "telephone_number": "417-588-3404",
            "fax_number": "417-588-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S MONROE",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363570",
            "telephone_number": "417-588-3404",
            "fax_number": "417-588-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY DIANE JOHNSON TMD OUTLET",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/ABC CERTIFIED FITTER (REM0094",
        "authorized_official_telephone_number": "417-588-3404",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "174584",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Love, CRNA
• Allie M Marshall, LCSW
• Jerilie Marshall, LPC, MS, NCC
• Lisa J Martin-Leckenby, LCSW
• Stephanie Suzanne Martin, LPC
• Karissa Massey
• Curtis D Mather, DO
• Mattax Neu Prater Eye Center, Inc.
• Mattax Neu Prater Eye Center, Inc.
• Quentin Doyle Maxwell, PLPC

• Orthotic Fitter in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Orthotic Fitter in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.

Verify at the official NPI Registry.