1649473422 NPI number — MRS. SUZANNE BROWN SWEDBERG PT, MHS

Table of content: MRS. SUZANNE BROWN SWEDBERG PT, MHS (NPI 1649473422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649473422 NPI number — MRS. SUZANNE BROWN SWEDBERG PT, MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEDBERG
Provider First Name:
SUZANNE
Provider Middle Name:
BROWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649473422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CANOY LANE
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
CLEMSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-654-2001
Provider Business Mailing Address Fax Number:
800-305-7112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 CANOY LANE
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
CLEMSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-654-2001
Provider Business Practice Location Address Fax Number:
800-305-7112
Provider Enumeration Date:
06/07/2007

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: 225100000X , with the licence number:  1551 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com