Dickson Community Clinic, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

DICKSON COMMUNITY CLINIC, INC.

Practice address

114 Highway 70 E Ste a-5
Dickson, TN 37055-7030

Phone

(615) 441-1486

Fax

(615) 441-1493

NPI assigned

May 3, 2021

Organization subpart

No

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

Authorized official

Name

Vicki Marie Terry

Title

Executive Director

Phone

(615) 979-4105

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Rural health clinic certification: CCN 883953

Legal name

DICKSON COMMUNITY CLINIC INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 7, 2023

Last certification

Dec 7, 2023

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

May 6, 2005 in TN

Enrollment address

114 Highway 70 E
Ste a-5
Dickson, TN 37055-7030

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1225611692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 HIGHWAY 70 E STE A-5",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370557030",
            "telephone_number": "615-441-1486",
            "fax_number": "615-441-1493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HIGHWAY 70 E STE A-5",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370557030",
            "telephone_number": "615-441-1486",
            "fax_number": "615-441-1493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "615-979-4105"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shweta Desai, PHARM. D.
• Elizabeth Marie Dessify
• Developmental Services of Dickson County, Inc.
• Dialysis Clinic Inc.
• Sandra Marie Dicks, OTR/L
• Dickson County Office of County Mayor
• Dickson County Schools
• Dickson Ear, Nose & Throat PLC
• Dickson Healthcare and Rehab LLC
• Dickson Healthcare LLC

• Rural Health Clinic/Center in Dickson, TN
• Providers in Dickson, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.