MEDICARE: KAREN R DIXON

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

General Provider Information

NPI Number	:	1912105156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN R DIXON

Provider Business Mailing Address
First Line	:	PO BOX 126053
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-0053
Country	:	US
Telephone Number	:	817-249-0485
Fax Number	:	817-249-3405

Provider Business Practice Location Address
First Line	:	1022 JOHNSON ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2630
Country	:	US
Telephone Number	:	817-249-0485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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