1639324411 NPI number — MR. WILLIAM BOYCE SWANN JR. RT(R)(MR)

Table of content: BRIAN NGUYEN (NPI 1275902264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639324411 NPI number — MR. WILLIAM BOYCE SWANN JR. RT(R)(MR)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANN
Provider First Name:
WILLIAM
Provider Middle Name:
BOYCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
RT(R)(MR)
Provider Gender Code:
M

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:
1639324411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-9118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 VETERANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-6444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-255-2121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2008

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: 2471M1202X , with the licence number:  3179 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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