Provider Demographics
NPI: | 1508508599 |
---|---|
Name: | DICKERSON SOLUTION |
Entity Type: | Organization |
Organization Name: | DICKERSON SOLUTION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DIONYSOS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DICKERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RT |
Authorized Official - Phone: | 707-740-3893 |
Mailing Address - Street 1: | 3490 RENNER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORTUNA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95540-3105 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 707-740-3893 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3490 RENNER DR |
Practice Address - Street 2: | |
Practice Address - City: | FORTUNA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95540-3105 |
Practice Address - Country: | US |
Practice Address - Phone: | 707-740-3893 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-04-11 |
Last Update Date: | 2022-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2279P1004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Pulmonary Diagnostics | Group - Multi-Specialty |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 2278P1006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Function Technologist | Group - Multi-Specialty |
No | 2279P1005X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Pulmonary Rehabilitation | Group - Multi-Specialty |
No | 2279P1006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Pulmonary Function Technologist | Group - Multi-Specialty |
No | 2279P4000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Patient Transport | Group - Multi-Specialty |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | Group - Multi-Specialty |