Provider Demographics
NPI:1356444699
Name:DICKSON MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:DICKSON MEDICAL ASSOCIATES, PC
Other - Org Name:DMA CHILDRENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGHTHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-441-4477
Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:114 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7030
Practice Address - Country:US
Practice Address - Phone:615-441-4530
Practice Address - Fax:615-446-1357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DICKSON MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3158185OtherBCBS TN GROUP PIN
CH3856OtherRAILROAD MEDICARE PIN
TN3721355Medicaid
0325720002Medicare NSC
TN3721355Medicare PIN