Provider Demographics
NPI:1972608537
Name:PULMONARY MEDICINE OF DICKSON, LLC
Entity Type:Organization
Organization Name:PULMONARY MEDICINE OF DICKSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-446-1260
Mailing Address - Street 1:111 HIGHWAY 70 E
Mailing Address - Street 2:3RD FLOOR SUITE A
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2080
Mailing Address - Country:US
Mailing Address - Phone:615-446-1260
Mailing Address - Fax:615-446-1265
Practice Address - Street 1:111 HIGHWAY 70 E
Practice Address - Street 2:3RD FLOOR SUITE A
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-446-1260
Practice Address - Fax:615-446-1265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL GROUP - DICKSON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725580Medicaid
TN3725580Medicare PIN