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NPI Code Detail

MEDICARE: RITA M DIXON PAC

MEDICARE: RITA M DIXON PAC
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
1363AM0700XMedical Physician Assistant1366SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11366OTHERSCSC LICENSE

General Provider Information

NPI Number : 1215180278
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA M DIXON PAC
Provider Business Mailing Address
First Line : 6311 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1445
Country : US
Telephone Number : 803-216-3959
Fax Number : 803-328-0553
Provider Business Practice Location Address
First Line : 6311 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1445
Country : US
Telephone Number : 803-216-3959
Fax Number : 803-328-0553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2008
Last Update Date : 11/14/2024

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