1720267958 NPI number — MRS. DIXIE P RICHARDSON

Table of content: MRS. DIXIE P RICHARDSON (NPI 1720267958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720267958 NPI number — MRS. DIXIE P RICHARDSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
DIXIE
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
PAMI-JO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720267958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 974
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLIARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43026-0974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-527-7756
Provider Business Mailing Address Fax Number:
614-527-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3220 LOWELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43204-4121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-527-7756
Provider Business Practice Location Address Fax Number:
614-527-7756
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2341380 . This is a "INDEPENDENT PROVIDER MEDI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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