1316194533 NPI number — GNIEWOMIRA P SWALDEK MD

Table of content: GNIEWOMIRA P SWALDEK MD (NPI 1316194533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316194533 NPI number — GNIEWOMIRA P SWALDEK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWALDEK
Provider First Name:
GNIEWOMIRA
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316194533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 SETON CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-5290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-407-8686
Provider Business Mailing Address Fax Number:
512-421-4489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 KYLE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KYLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78640-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-504-5000
Provider Business Practice Location Address Fax Number:
512-324-1984
Provider Enumeration Date:
08/19/2008

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: 207R00000X , with the licence number:  LP01549 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD441371 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: P4719 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 337568502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 337568501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".