1598812307 NPI number — DR. WENDY WOODS-SWAFFORD MD

Table of content: DR. WENDY WOODS-SWAFFORD MD (NPI 1598812307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598812307 NPI number — DR. WENDY WOODS-SWAFFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS-SWAFFORD
Provider First Name:
WENDY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598812307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 PLEASENT ST.
Provider Second Line Business Mailing Address:
STE. 306
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-8912
Provider Business Mailing Address Fax Number:
515-241-8988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 PLEASENT ST.
Provider Second Line Business Practice Location Address:
STE. 306
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-8912
Provider Business Practice Location Address Fax Number:
515-241-8988
Provider Enumeration Date:
01/04/2007

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: 37743 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1598812307 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175150047 . This is a "MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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