1245791623 NPI number — HOLLISTER CHRISTIAN SWANSON MD

Table of content: HOLLISTER CHRISTIAN SWANSON MD (NPI 1245791623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245791623 NPI number — HOLLISTER CHRISTIAN SWANSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
HOLLISTER
Provider Middle Name:
CHRISTIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1245791623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 HOLMES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64108-2640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-404-4175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4475 WILSON AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49418-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-949-2600
Provider Business Practice Location Address Fax Number:
616-588-6547
Provider Enumeration Date:
03/27/2019

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 , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 4301513410 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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