Organization
DICKENSON MEDICAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RIMON IBRAHIM M.D. (PRESIDENT)
(276) 926-4601
Entity
Organization
Contact information
Practice address
5607 DICKENSON HWY, CLINTWOOD, VA 24228-7009
(276) 926-4601
(276) 926-4602
Mailing address
PO BOX 2224, CLINTWOOD, VA 24228-2224
(276) 926-4601
(276) 926-4602
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101051077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010264995
—
VA
Enumeration date
06/15/2006
Last updated
03/31/2010
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