Provider Demographics
NPI:1205312352
Name:DIXIE INFUSION CLINIC, LLC
Entity type:Organization
Organization Name:DIXIE INFUSION CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOONUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-525-3142
Mailing Address - Street 1:650 W LINCOLN TRAIL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2681
Mailing Address - Country:US
Mailing Address - Phone:270-506-2463
Mailing Address - Fax:
Practice Address - Street 1:650 W LINCOLN TRAIL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2681
Practice Address - Country:US
Practice Address - Phone:270-506-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
K045392OtherMEDICARE PART B