Provider Demographics
NPI:1174388078
Name:DICKINSON FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:DICKINSON FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-689-5870
Mailing Address - Street 1:1455 FM 646 RD W STE 100
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-2038
Mailing Address - Country:US
Mailing Address - Phone:346-689-5870
Mailing Address - Fax:949-695-4309
Practice Address - Street 1:1455 FM 646 RD W STE 100
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-2038
Practice Address - Country:US
Practice Address - Phone:346-689-5870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty