Organization
DIXON FAMILY PRACTICE AND INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLENE S MCMILLIAN FNP (OWNER)
(573) 759-3030
Entity
Organization
Contact information
Practice address
206 WEST 2ND STREET, DIXON, MO 65459-0940
(573) 759-3030
(573) 759-3131
Mailing address
PO BOX 9900, DIXON, MO 65459-0940
(573) 759-3030
(573) 759-3131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R6D44
MO
261QR1300X
Rural Health Clinic/Center
Primary
263875
MO
363LF0000X
Family Nurse Practitioner
113217
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508937000
—
MO
05
—
598937001
—
MO
Enumeration date
06/21/2005
Last updated
04/29/2008
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