1225611692 NPI number — DICKSON COMMUNITY CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225611692 NPI number — DICKSON COMMUNITY CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DICKSON COMMUNITY CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225611692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 HIGHWAY 70 E STE A-5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37055-7030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-441-1486
Provider Business Mailing Address Fax Number:
615-441-1493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 HIGHWAY 70 E STE A-5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37055-7030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-441-1486
Provider Business Practice Location Address Fax Number:
615-441-1493
Provider Enumeration Date:
05/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
615-979-4105

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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