DICKENSON MEDICAL CLINIC PC
NPI 1033153879
Clinic/Center - Primary Care in Clintwood, VA

Q: What is Dickenson Medical Clinic PC's NPI number?

The NPI number for Dickenson Medical Clinic PC is 1033153879. It was assigned to this organization in the NPPES registry on June 15, 2006.

Q: What is Dickenson Medical Clinic PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Active since June 15, 2006CLIA 49D1055252 · Waiver

5607 DICKENSON HWY, CLINTWOOD, VA 24228(276) 926-4601(276) 926-4602 Get Directions Write a Review

NPPES record last updated: March 31, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About Dickenson Medical Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DICKENSON MEDICAL CLINIC PC (NPI 1033153879) is a healthcare organization registered as a primary care in Clintwood, Virginia and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through June 12, 2028 and lists Rimon Ibrahim, President, as its authorized official.

NPPES Registry Identity

NPI1033153879

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NameDICKENSON MEDICAL CLINIC PC

Location Address5607 DICKENSON HWYClintwood, VA 24228-7009

Mailing AddressPo Box 2224Clintwood, VA 24228-2224 · (276) 926-4601 · Fax (276) 926-4602

Phone(276) 926-4601

Fax(276) 926-4602

Organization SubpartNo

Authorized OfficialRimon IbrahimPresident · (276) 926-4601

Enumeration DateJune 15, 2006

Last NPPES UpdateMarch 31, 2010

✔ NPI 1033153879 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

License✔ Licensed in VA · 0101051077

5607 DICKENSON HWY, Clintwood, VA 24228

Open in Google Maps ↗

Other Identifiers 3

Medicare UPINF82939VA

Medicaid010264995VA

Medicare UPINQ74817

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1055252

Dickenson Medical Clinic · Clintwood, VA

Active · expires Jun 12, 2028

CLIA Number49D1055252

Laboratory TypePhysician Office

Certificate Effective DateJune 13, 2026

Certificate Expiration DateJune 12, 2028

Laboratory DirectorRimon Ibrahim

Laboratory Phone(276) 926-4601

Laboratory LocationDickenson Medical Clinic5607 Dickenson Hwy, Clintwood, VA 24228

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DICKENSON AFTER HOURS CLINIC, INC

Clinic/Center (Primary Care)