MARY DIANE JOHNSON TMD OUTLET NPI 1649389388

NPI Information

NPI: 1649389388
Provider Name: MARY DIANE JOHNSON TMD OUTLET
Classification: Orthotic Fitter - 225000000X
Entity Type: Organization
Address: 702 S MONROE
LEBANON, MO
ZIP 65536
Phone: (417) 588-3404

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NPI Details

MARY DIANE JOHNSON TMD OUTLET is an orthotic fitter in Lebanon, MO. The provider is an individual trained in the management of fitting prefabricated orthoses. MARY DIANE JOHNSON TMD OUTLET NPI is 1649389388. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

702 S MONROE
LEBANON, MO
ZIP 65536-570
Phone: (417) 588-3404
Fax: (417) 588-3404

The provider's authorized official is Mary D Johnson .
The authorized official title is Owner/abc Certified Fitter (rem0094 and has the following contact phone number (417) 588-3404.

The enumeration date for this NPI number is 8/29/2006 and was last updated on 6/16/2008.

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	225000000X	Orthotic Fitter				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========TMD	OTHER	MISSOURI	ST. JOHN'S PREMIER INS.
2	0780990001	MEDICARE NSC	MISSOURI
3	174584	OTHER	MISSOURI	BLUE CROSS/BLUE SHIELD

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: 11/21/2025

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