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Dianne Laroche Johnson

Radiology

Allopathic & Osteopathic Physicians

3599 University Blvd. S., Bldg. 300, Jacksonville, FL 32216-0000

PECOS Enrollment

This provider is enrolled in PECOS as DIANNE JOHNSON.

Based on the most recent information from CMS, provider Dianne Laroche Johnson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1538150610
Provider Type
Individual
Full Name
Johnson, Dianne Laroche
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
10/29/2005
Last Updated
8/21/2017

Contact Information

Practice Location

3599 University Blvd. S., Bldg. 300, Jacksonville, FL 32216-0000

(904) 399-5550

(904) 346-4334

Mailing Location

3599 University Blvd. S., Bldg. 300, Jacksonville, FL 32216-0000

(904) 399-5550

(904) 346-4334

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License ME93196 Florida

Provider Identifiers

ID	Description	Issuer
ID P00319147	Description Other	Issuer RAILROAD MEDICARE Georgia
ID 109749741A	Description Medicaid	Issuer Unlisted Georgia
ID 275351100	Description Medicaid	Issuer Unlisted Florida

Dianne Laroche Johnson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

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ID

Description

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