Provider Demographics
NPI:1255815619
Name:DIXIE INFUSION PHARMACY, LLC
Entity type:Organization
Organization Name:DIXIE INFUSION PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVAS
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:YOONUS-KUNJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-525-3142
Mailing Address - Street 1:311 LANDRUM PL STE 600
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6319
Mailing Address - Country:US
Mailing Address - Phone:931-241-5655
Mailing Address - Fax:931-241-5654
Practice Address - Street 1:311 LANDRUM PL STE 600
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6319
Practice Address - Country:US
Practice Address - Phone:931-241-5655
Practice Address - Fax:931-241-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G700425OtherLOCAL MEDICARE - PART B