1386726925 NPI number — SWAIN ASSOCIATES SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386726925 NPI number — SWAIN ASSOCIATES SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWAIN ASSOCIATES SC
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:
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:
1386726925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N WABASH AVE
Provider Second Line Business Mailing Address:
APT 4605
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-3591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-527-5729
Provider Business Mailing Address Fax Number:
312-527-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N WABASH AVE
Provider Second Line Business Practice Location Address:
APT 4605
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-3591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-527-5729
Provider Business Practice Location Address Fax Number:
312-527-2103
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWAIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-527-5729

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31603356 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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