1265456867 NPI number — DR. KAY GIRVIN SWAFFORD PHD

Table of content: DR. KAY GIRVIN SWAFFORD PHD (NPI 1265456867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265456867 NPI number — DR. KAY GIRVIN SWAFFORD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAFFORD
Provider First Name:
KAY
Provider Middle Name:
GIRVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWAFFORD
Provider Other First Name:
KATY
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1265456867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3355 BEE CAVE RD
Provider Second Line Business Mailing Address:
BUILDING 1, SUITE 104
Provider Business Mailing Address City Name:
WEST LAKE HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-328-8820
Provider Business Mailing Address Fax Number:
512-322-0897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3355 BEE CAVE RD
Provider Second Line Business Practice Location Address:
BUILDING 1, SUITE 104
Provider Business Practice Location Address City Name:
WEST LAKE HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-328-8820
Provider Business Practice Location Address Fax Number:
512-322-0897
Provider Enumeration Date:
07/27/2006

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: 103TC0700X , with the licence number:  2-4745 , 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: 680014809 . This is a "RR MCARE 635R" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 83346P . This is a "BCBS 635R" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100336004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83151P . This is a "BCBS 632R" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 680014100 . This is a "RR MCARE 632R" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100336005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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