NPIMap

Organization Active NPI

Dixie Infusion Pharmacy, LLC

Doing business as Dixie Vital Care of Madison

  • Infusion Therapy Clinic/Center
  • Madison, TN
National Provider Identifier
1245722685
Registry record updated Jun 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X
Legal business name
DIXIE INFUSION PHARMACY, LLC
Doing business as
Dixie Vital Care of Madison
Practice address
1210 Briarville Rd Ste 502
Madison, TN 37115-5141
Phone
(615) 241-0387
Fax
(888) 590-5567
NPI assigned
Jun 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2018

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

Authorized official

Name
Navas Sofia Yoonus-Kunju
Title
Owner
Phone
(615) 525-3142

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X TN Primary

Addresses

Primary practice location

1210 Briarville Rd Ste 502
Madison, TN 37115-5141

Mailing address

1210 Briarville Rd Ste 502
Madison, TN 37115-5141
Phone (615) 241-0387

Other names 1

  • Dixie Vital Care of Madison Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181006000123 TN Part B Supplier - Clinic/Group Practice 5991087868 Receives reassigned benefits from 1 practitioner
Practice locations: Madison, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Dixie Infusion Pharmacy LLC2 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1210 Briarville Rd
Ste 502
Madison, TN 37115
Phone (615) 241-0387

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527811200000",
    "number": "1245722685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 BRIARVILLE RD STE 502",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371155141",
            "telephone_number": "615-241-0387",
            "fax_number": "888-590-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 BRIARVILLE RD STE 502",
            "city": "MADISON",
            "state": "TN",
            "postal_code": "371155141",
            "telephone_number": "615-241-0387",
            "fax_number": "888-590-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIE INFUSION PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-01",
        "last_updated": "2018-06-01",
        "status": "A",
        "authorized_official_last_name": "YOONUS-KUNJU",
        "authorized_official_first_name": "NAVAS",
        "authorized_official_middle_name": "SOFIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-525-3142"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dixie Vital Care of Madison",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.