1154702892 NPI number — JEFFREY A SWEAT MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154702892 NPI number — JEFFREY A SWEAT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY A SWEAT MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154702892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 SCRIPPS DR
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-6319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-925-3912
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 SCRIPPS DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-6319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-925-3912
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SWEAT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
DOCTOR OF MEDICINE
Authorized Official Telephone Number:
916-925-3912

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  A95293 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13526460 . This is a "CAQH ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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