Provider Demographics
NPI:1902839939
Name:DIXON MEDICAL SUPPLIES AND SERVICES LLC
Entity Type:Organization
Organization Name:DIXON MEDICAL SUPPLIES AND SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-341-2100
Mailing Address - Street 1:16633 LIVERNOIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3098
Mailing Address - Country:US
Mailing Address - Phone:313-341-2100
Mailing Address - Fax:313-341-3500
Practice Address - Street 1:16633 LIVERNOIS AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-3098
Practice Address - Country:US
Practice Address - Phone:313-341-2100
Practice Address - Fax:313-341-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675791Medicaid
MI540H224740OtherBLUE CROSS BLUE SHIELD
MI540H224740OtherBLUE CROSS BLUE SHIELD MI
MI540H224740OtherBLUE CROSS BLUE SHIELD
MI4675791Medicaid