Basic Information
| Provider Information | |||||||||
| NPI: | 1629057401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DILLON FAMILY MEDICINE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 N 6TH AVE | ||||||||
| Address2: | P O BOX 1069 | ||||||||
| City: | DILLON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295362503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437747336 | ||||||||
| FaxNumber: | 8437745656 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 N 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295362503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437747336 | ||||||||
| FaxNumber: | 8437745656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8437747336 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8827 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | PA294-2 | 05 | SC | MEDICAID | CB3397 | 01 | SC | RAILROAD MEDICARE | OTHER | 8901432 | 05 | NC | MEDICAID |