1689785305 NPI number — JEFFREY V SWEARINGEN MD

Table of content: JEFFREY V SWEARINGEN MD (NPI 1689785305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689785305 NPI number — JEFFREY V SWEARINGEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEARINGEN
Provider First Name:
JEFFREY
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1689785305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 W. PARK ST.
Provider Second Line Business Mailing Address:
BWPC
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-383-6792
Provider Business Mailing Address Fax Number:
217-383-4752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 E WINDSOR RD
Provider Second Line Business Practice Location Address:
FAMILY MEDICINE
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61802-9566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-255-9670
Provider Business Practice Location Address Fax Number:
217-255-9724
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  036066504 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080042557 . This is a "RAIL ROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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