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General NPI Number Information
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NPI Number | 1235135682
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Entity Type | Organization
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Legal Business Name | DIXON FAMILY PRACTICE AND INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 206 WEST 2ND STREET
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City | DIXON
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State | MO
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Zip | 65459-0940
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Country | US
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Telephone | 573-759-3030
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Fax | 573-759-3131
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Provider Business Mailing Address
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Address Line | PO BOX 9900
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City | DIXON
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State | MO
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Zip | 65459-0940
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Country | US
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Telephone | 573-759-3030
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Fax | 573-759-3131
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Authorized Official
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Title or Position | OWNER
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Name | CARLENE S MCMILLIAN
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Credential | FNP
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Telephone | 573-759-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R6D44
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 113217
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 263875
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License Number State | MO
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