Provider Demographics
NPI:1699899005
Name:DICKSON MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:DICKSON MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIFLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-446-7444
Mailing Address - Street 1:2073 HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-3152
Mailing Address - Country:US
Mailing Address - Phone:615-446-7444
Mailing Address - Fax:
Practice Address - Street 1:2073 HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-3152
Practice Address - Country:US
Practice Address - Phone:615-446-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25580333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000000710OtherSTATE LICENSE
TN4682220002Medicare ID - Type Unspecified