Basic Information
| Provider Information | |||||||||
| NPI: | 1295725851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 S BLOOMINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656582753 | ||||||||
| FaxNumber: | 7656552604 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 S MURPHY AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BRAZIL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478348296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124422100 | ||||||||
| FaxNumber: | 8124464409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02002070 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200853600A | 05 | IN | MEDICAID | P00416616 | 01 | IN | RAILROAD MEDICARE | OTHER | 200300810 | 05 | IN | MEDICAID | 153869 | 01 | IN | RURAL HEALTH | OTHER | 200286610 | 05 | IN | MEDICAID |