DICKSON STREET CLINIC NPI 1427236926

NPI Information

  • NPI: 1427236926
  • Provider Name: DICKSON STREET CLINIC
  • Classification: Family Medicine - 207QA0505X
  • Specialization: Adult Medicine
  • Entity Type: Organization
  • Address: 102 W DICKSON ST
    FAYETTEVILLE, AR
    ZIP 72701
  • Phone: (479) 521-1114

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NPI Details

DICKSON STREET CLINIC is an adult medicine family medicine in Fayetteville, AR. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. DICKSON STREET CLINIC NPI is 1427236926. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

102 W DICKSON ST
FAYETTEVILLE, AR
ZIP 72701-219
Phone: (479) 521-1114
Fax: (479) 521-2540

The provider's authorized official is Carl R Magness .
The authorized official title is Owner/physician and has the following contact phone number (479) 521-1114.

The enumeration date for this NPI number is 2/6/2008 and was last updated on 2/6/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QA0505XFamily MedicineAdult MedicineC4954ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D16969MEDICARE UPINARKANSAS
25C742MEDICARE PINARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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