SHAD CARL JOHNSON PA-C NPI 1114028354

NPI Information

NPI: 1114028354
Provider Name: SHAD CARL JOHNSON, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: POCATELLO HEALTH SERVICES LLC

PECOS Registration: Yes

Address:
1151 HOSPITAL WAY BLDG A
POCATELLO, ID
ZIP 83201
Phone: (208) 232-6616
Get Directions

Shad Carl Johnson, PA-C is a medical physician assistant in Pocatello, ID with 18 years of experience. Shad Carl Johnson, PA-C NPI is 1114028354. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1151 HOSPITAL WAY BLDG A
POCATELLO, ID
ZIP 83201-763
Phone: (208) 232-6616
Fax: (208) 232-6618

The NPI 1114028354 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA-629	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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