Provider Demographics
NPI:1689621179
Name:DIXON DIALYSIS SERVICES INC
Entity Type:Organization
Organization Name:DIXON DIALYSIS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-678-6433
Mailing Address - Street 1:125 N LINCOLN ST
Mailing Address - Street 2:STE B
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3259
Mailing Address - Country:US
Mailing Address - Phone:707-678-6433
Mailing Address - Fax:707-678-4879
Practice Address - Street 1:125 N LINCOLN ST
Practice Address - Street 2:STE B
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3259
Practice Address - Country:US
Practice Address - Phone:707-678-6433
Practice Address - Fax:707-678-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052825Medicare Oscar/Certification