Johnson Blackburn

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

20874 Issued in NC

Legal business name

JOHNSON BLACKBURN

Practice address

111 E Southerland St
Wallace, NC 28466-2326

Phone

(910) 285-3134

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Michael J Blackburn

Title

Manager

Phone

(910) 285-3134

Specialties & licenses 1

Addresses

Other names 1

• Pages Home Store Doing business as

Locations

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1669665394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E SOUTHERLAND ST",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284662326",
            "telephone_number": "910-285-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E SOUTHERLAND ST",
            "city": "WALLACE",
            "state": "NC",
            "postal_code": "284662326",
            "telephone_number": "910-285-3134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON BLACKBURN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-285-3134",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "20874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pages Home Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jemma Holley Imwalle, CCC-SLP
• Instride Foot and Ankle Specialists, PLLC
• Interim Healthcare of the Eastern Carolinas, Inc
• Michael James, LSC, NCC, LCMHCA,
• Jeffrey B Pupp
• Mary Anna Johnson, FNP-BC
• Kelly Chiropractic Center of Wallace
• Kidzcare Pediatrics, PC
• Ashley B King, PA-C
• Mary E King, DC

• All providers in Wallace, NC
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.