1356751929 NPI number — JAMES DEREK SWORD DO

Table of content: JAMES DEREK SWORD DO (NPI 1356751929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356751929 NPI number — JAMES DEREK SWORD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWORD
Provider First Name:
JAMES
Provider Middle Name:
DEREK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1356751929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 BYPASS ROAD
Provider Second Line Business Mailing Address:
PIKEVILLE MEDICAL CENTER RESIDENCY PROGRAM
Provider Business Mailing Address City Name:
PIKEVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-218-3985
Provider Business Mailing Address Fax Number:
606-218-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 BYPASS ROAD
Provider Second Line Business Practice Location Address:
PIKEVILLE MEDICAL CENTER RESIDENCY PROGRAM
Provider Business Practice Location Address City Name:
PIKEVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-218-3985
Provider Business Practice Location Address Fax Number:
606-218-4620
Provider Enumeration Date:
05/05/2014

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: 207P00000X , with the licence number:  04006 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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