1083615801 NPI number — JIMMY D. SWANSON, MD, INC.

Table of content: (NPI 1447587225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083615801 NPI number — JIMMY D. SWANSON, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIMMY D. SWANSON, MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SWANSON ORTHOPAEDIC SURGERY AND SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1083615801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47025-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-537-8402
Provider Business Mailing Address Fax Number:
812-537-8425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
272 BIELBY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-537-8402
Provider Business Practice Location Address Fax Number:
812-537-8425
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SWANSON
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-537-8402

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  01037561 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 35-05-3520-S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0251123-003 . This is a "CIGNA RENDERING #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 645223 . This is a "AETNA RENDERING #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010025828 . This is a "RAILROAD MEDICARE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000014822 . This is a "BLUE SHIELD INDIANA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 53520 . This is a "CHOICE CARE RENDERING #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0901330 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100017200A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124097500 . This is a "DEPT OF LABOR PIN" identifier . This identifiers is of the category "OTHER".




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