Provider Demographics
NPI:1124376686
Name:DYESS MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:DYESS MEDICAL SERVICES, INC
Other - Org Name:FIRST MED OF ELBA
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DYESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-897-2207
Mailing Address - Street 1:252 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-5102
Mailing Address - Country:US
Mailing Address - Phone:334-897-2207
Mailing Address - Fax:334-853-0128
Practice Address - Street 1:252 LARKIN RD
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-5102
Practice Address - Country:US
Practice Address - Phone:334-897-2207
Practice Address - Fax:334-853-0128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty