MEDICARE: GLEN CITY MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205857398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEN CITY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	247 MARCH ST
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-2511
Country	:	US
Telephone Number	:	805-933-6622
Fax Number	:	806-933-6629

Provider Business Practice Location Address
First Line	:	247 MARCH ST
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-2511
Country	:	US
Telephone Number	:	805-933-6622
Fax Number	:	806-933-6629

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL SWARTOUT
Credential	:	M.D.
Telephone Number	:	805-933-6622

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	01/16/2012

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Directions to “GLEN CITY MEDICAL GROUP, INC ” Practice Location

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