1821290974 NPI number — WILLIAM ROY SWANKE MD

Table of content: WILLIAM ROY SWANKE MD (NPI 1821290974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821290974 NPI number — WILLIAM ROY SWANKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANKE
Provider First Name:
WILLIAM
Provider Middle Name:
ROY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWANKE
Provider Other First Name:
WILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821290974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15414 SMOKEY PT BLVD
Provider Second Line Business Mailing Address:
339
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98271-5953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-387-9544
Provider Business Mailing Address Fax Number:
360-387-8884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15414 SMOKEY PT BLVD
Provider Second Line Business Practice Location Address:
339
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98271-5953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-387-9544
Provider Business Practice Location Address Fax Number:
360-387-8884
Provider Enumeration Date:
06/01/2007

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: 2084N0400X , with the licence number:  M9229 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: MD00029231 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: G16633 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: G16633 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MD00029231 . This is a "MD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1072263 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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