1649243957 NPI number — MS. SUSAN J SWIFT DO

Table of content: MS. SUSAN J SWIFT DO (NPI 1649243957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649243957 NPI number — MS. SUSAN J SWIFT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWIFT
Provider First Name:
SUSAN
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARR
Provider Other First Name:
SUSAN
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649243957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 E. JEFFERSON STREET
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52245-2479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-354-2653
Provider Business Mailing Address Fax Number:
319-339-1364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E. MARKET STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245-2689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-354-2653
Provider Business Practice Location Address Fax Number:
319-339-1364
Provider Enumeration Date:
02/08/2006

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: 207L00000X , with the licence number:  02330 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1649243957 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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