Provider Demographics
NPI:1487057634
Name:CHRISTIAN M. DICKSON
Entity type:Organization
Organization Name:CHRISTIAN M. DICKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MG.
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAJORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-4230
Mailing Address - Street 1:5920 SARATOGA BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4118
Mailing Address - Country:US
Mailing Address - Phone:361-993-4230
Mailing Address - Fax:361-993-5680
Practice Address - Street 1:5920 SARATOGA BLVD STE 630
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4118
Practice Address - Country:US
Practice Address - Phone:361-993-4230
Practice Address - Fax:361-993-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1463332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083693907Medicare NSC