MEDICARE: FLOYD D DIX

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	1041C0700X	Clinical Social Worker	34001107A	IN

General Provider Information

NPI Number	:	1710226592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOYD D DIX

Provider Business Mailing Address
First Line	:	2512 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1404
Country	:	US
Telephone Number	:	765-497-3932
Fax Number	:	765-807-0225

Provider Business Practice Location Address
First Line	:	2512 COVINGTON ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1404
Country	:	US
Telephone Number	:	765-497-3932
Fax Number	:	765-807-0225

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	FLOYD D DIX
Credential	:	LCSW
Telephone Number	:	812-345-1087

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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