1104058213 NPI number — DR. FREDDIE R SWAIN M.D.

Table of content: DR. FREDDIE R SWAIN M.D. (NPI 1104058213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104058213 NPI number — DR. FREDDIE R SWAIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAIN
Provider First Name:
FREDDIE
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1104058213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FRANKLIN ST SE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-4537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-539-0457
Provider Business Mailing Address Fax Number:
256-539-5827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FRANKLIN ST SE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-539-0457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2009

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: 2085R0202X , with the licence number:  56707 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 57686 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD60479384 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD.36376 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206371 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206380 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207599 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210440 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 238645 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 512.-36317 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 13587482 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207600 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207768 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208805 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210146 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1588621296 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 211029 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 512-04929 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 247994 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 248628 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 512-36316 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 266342 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 512-36517 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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