Provider Demographics
NPI:1578648101
Name:DICKSON ORTHOPAEDIC CENTERS
Entity Type:Organization
Organization Name:DICKSON ORTHOPAEDIC CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-225-6800
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:#410
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-225-6800
Mailing Address - Fax:501-225-6898
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:#410
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-225-6800
Practice Address - Fax:501-225-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5427418OtherAETNA
AR14302000000OtherQUALCHOICE
AR51359OtherBLUE CROSS AND BLUE SHIEL
AR5427418OtherAETNA
AR14302000000OtherQUALCHOICE