1376704445 NPI number — DR. AMANDA ERIN BRISTOL SWANSON M.D.

Table of content: DR. AMANDA ERIN BRISTOL SWANSON M.D. (NPI 1376704445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376704445 NPI number — DR. AMANDA ERIN BRISTOL SWANSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISTOL SWANSON
Provider First Name:
AMANDA
Provider Middle Name:
ERIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376704445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1019 PACIFIC AVENUE
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98402-4488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-722-1540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 SOUTH I STREET
Provider Second Line Business Practice Location Address:
DOWNTOWN CLINIC - COMMUNITY HEALTH CARE
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-597-3813
Provider Business Practice Location Address Fax Number:
253-597-3815
Provider Enumeration Date:
06/21/2008

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: 207Q00000X , with the licence number:  MD60213498 , 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)





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