| Organization Name: | DICKENSON MEDICAL CLINIC PC |
| NPI Number: | 1033153879 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RIMON IBRAHIM (PRESIDENT) |
| Mailing Address: | 5607 Dickenson Hwy Clintwood |
| State: | VA US |
| Postal Code: | 242287009 |
| Phone Number: | 2769264601 |
| Fax Number: | 2769264602 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 03/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 0101051077 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |