1174576029 NPI number — DR. CAROL ANN SWANSON MD

Table of content: DR. CAROL ANN SWANSON MD (NPI 1174576029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174576029 NPI number — DR. CAROL ANN SWANSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
CAROL
Provider Middle Name:
ANN
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:
1174576029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
STE A-100 ARIZONA COMMUNITY PHYSICIANS PC
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-327-0460
Provider Business Mailing Address Fax Number:
520-795-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 N LA CHOLLA BLVD
Provider Second Line Business Practice Location Address:
CASAS ADOBES PEDIATRICS
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-751-3675
Provider Business Practice Location Address Fax Number:
520-547-5767
Provider Enumeration Date:
05/19/2006

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: 208000000X , with the licence number:  20031 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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