Basic Information
| Provider Information | |||||||||
| NPI: | 1518143320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DILLON FAMILY MEDICINE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1069 | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295361069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437747336 | ||||||||
| FaxNumber: | 8437743745 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 N 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295362503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437747336 | ||||||||
| FaxNumber: | 8437743745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8437747336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24070 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 240705 | 05 | SC | MEDICAID |