Provider Demographics
NPI:1033650817
Name:DICKSON ORTHOPEDICS, PA
Entity Type:Organization
Organization Name:DICKSON ORTHOPEDICS, PA
Other - Org Name:JONESBORO ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-1820
Mailing Address - Street 1:1416 E MATTHEWS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1416 E MATTHEWS
Practice Address - Street 2:SUITE 200
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4632
Practice Address - Country:US
Practice Address - Phone:870-932-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2017-016363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty