1285672717 NPI number — DRS SWANN & TALLENT, PA

Table of content: (NPI 1285672717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285672717 NPI number — DRS SWANN & TALLENT, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS SWANN & TALLENT, PA
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:
Provider Other Organization Name Type Code:
6
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:
1285672717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3111 SPRINGBANK LANE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-541-3603
Provider Business Mailing Address Fax Number:
704-541-3619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 SPRINGBANK LANE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-541-3603
Provider Business Practice Location Address Fax Number:
704-541-3619
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWANN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DENNIS
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
704-541-3603

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 3793 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X , with the licence number: 5881 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 5962 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 9535 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0607286 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01083 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8901083 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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