NPIMap

Organization Active NPI

Richard L Dickson, M.D.

Doing business as Sol Duc Clinic

  • Family Medicine Physician
  • Forks, WA
National Provider Identifier
1124210224
Registry record updated Sep 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
600372068 Issued in WA
Legal business name
RICHARD L DICKSON, M.D.
Doing business as
Sol Duc Clinic
Practice address
481 West E. St.
Forks, WA 98331-1918
Phone
(360) 374-6642
Fax
(360) 374-5335
NPI assigned
Aug 13, 2007
Last updated
Sep 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Richard Lee Dickson, M.D.NPI 1760455075
Title
Physician/Owner
Phone
(360) 374-6642

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 600372068 WA Primary

Addresses

Primary practice location

481 West E. St.
Forks, WA 98331-1918

Mailing address

PO Box 1918
Forks, WA 98331-1918
Phone (360) 374-6642

Other identifiers 2

IdentifierTypeStateIssuer
7075542MedicaidWA
59570OtherWADEPT OF L & I

Other names 1

  • Sol Duc Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Richard L Dickson2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

481 W E St
Forks, WA 98331
Phone (360) 374-6642

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1124210224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1918",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983311918",
            "telephone_number": "360-374-6642",
            "fax_number": "360-374-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 WEST E. ST.",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983311918",
            "telephone_number": "360-374-6642",
            "fax_number": "360-374-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD L DICKSON, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "360-374-6642",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "600372068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7075542",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L & I",
            "identifier": "59570",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sol Duc Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forks, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.