MEDICARE: DIXON MEDICAL SUPPLIES AND SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540H224740	OTHER	MI	BLUE CROSS BLUE SHIELD
3	540H224740	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1902839939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXON MEDICAL SUPPLIES AND SERVICES LLC

Provider Business Mailing Address
First Line	:	16633 LIVERNOIS AVE
Second Line	:	SUITE 1
City	:	DETROIT
State	:	MI
Zip	:	48221-3098
Country	:	US
Telephone Number	:	313-341-2100
Fax Number	:	313-341-3500

Provider Business Practice Location Address
First Line	:	16633 LIVERNOIS AVENUE
Second Line	:	SUITE 1
City	:	DETROIT
State	:	MI
Zip	:	48221-3098
Country	:	US
Telephone Number	:	313-341-2100
Fax Number	:	313-341-3500

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JASON DIXON
Credential	:
Telephone Number	:	313-341-2100

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/25/2012

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