1528394434 NPI number — ANSLEIGH BROOKE SWARTWOOD RD

Table of content: ANSLEIGH BROOKE SWARTWOOD RD (NPI 1528394434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528394434 NPI number — ANSLEIGH BROOKE SWARTWOOD RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWARTWOOD
Provider First Name:
ANSLEIGH
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROWAN
Provider Other First Name:
ANSLEIGH
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528394434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/17/2013
NPI Reactivation Date:
11/30/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6010 W AMARILLO BLVD.
Provider Second Line Business Mailing Address:
AMARILLO VA HEALTHCARE SYSTEM
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-355-9703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 W AMARILLO BLVD.
Provider Second Line Business Practice Location Address:
AMARILLO VA HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-9703
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2009

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: 133V00000X , with the licence number:  DT80573 , 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)