MEDICARE: N & R OF DIXON, 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	314000000X	Skilled Nursing Facility	030811	MO

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	18459587	OTHER	MO	STATE ID

General Provider Information

NPI Number	:	1699761080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N & R OF DIXON, LLC

Provider Business Mailing Address
First Line	:	403 E 10TH ST
Second Line	:
City	:	DIXON
State	:	MO
Zip	:	65459-6049
Country	:	US
Telephone Number	:	573-759-2135
Fax Number	:	573-759-2600

Provider Business Practice Location Address
First Line	:	403 E 10TH ST
Second Line	:
City	:	DIXON
State	:	MO
Zip	:	65459-6049
Country	:	US
Telephone Number	:	573-759-2135
Fax Number	:	573-759-2600

Authorized Official
Title or Position	:	MEMBER
Name	:	JAMES C LINCOLN
Credential	:
Telephone Number	:	573-481-9625

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/13/2014

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Directions to “N & R OF DIXON, LLC ” Practice Location

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