1871674515 NPI number — LAWRENCE C. SWAN, M.D.

Table of content: (NPI 1871674515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871674515 NPI number — LAWRENCE C. SWAN, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE C. SWAN, M.D.
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:
6
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:
1871674515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 WESTSIDE DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-339-1760
Provider Business Mailing Address Fax Number:
423-559-1483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 WESTSIDE DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-339-1760
Provider Business Practice Location Address Fax Number:
423-559-1483
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWAN
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-339-1760

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3032152 . This is a "MEDICARE IND- SWAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: G62659 . This is a "UPIN - SIMS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0078692 . This is a "BCBST GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 245331943 . This is a "TRICARE - SIMS INDIVIDUAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3032152 . This is a "MEDICAID - SWAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4052544 . This is a "BCBST IND - SIMS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 44D0309375 . This is a "CLIA - GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A99578 . This is a "UPIN - SWAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0078692 . This is a "BCBST IND - SWAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3719860 . This is a "MEDICARE GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3880829 . This is a "MEDICAID - SIMS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1584772 . This is a "GHI - SIMS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 272525633 . This is a "TRICARE - SWAN INDIVIDUAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3880829 . This is a "MEDICARE IND - SIMS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1584771 . This is a "GHI - SWAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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