1205981107 NPI number — MR. ANDREW C SWARTSEL PA-C

Table of content: MR. ANDREW C SWARTSEL PA-C (NPI 1205981107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205981107 NPI number — MR. ANDREW C SWARTSEL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWARTSEL
Provider First Name:
ANDREW
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWARTSEL
Provider Other First Name:
ANDY
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205981107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98812-1092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-689-6666
Provider Business Mailing Address Fax Number:
509-689-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 JASMINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-826-1600
Provider Business Practice Location Address Fax Number:
509-826-3633
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN00096318 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA10003662 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA10003662 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7676SW . This is a "ASURIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0198873 . This is a "L AND I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8906544 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8350068 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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