MEDICARE: JOHN R. SWENSON DPM, PC

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	213E00000X	Podiatrist	474	CO

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	:	1639352024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN R. SWENSON DPM, PC

Provider Business Mailing Address
First Line	:	2287 ROCKING HORSE CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-6401
Country	:	US
Telephone Number	:	719-473-6677
Fax Number	:	719-473-9219

Provider Business Practice Location Address
First Line	:	2287 ROCKING HORSE CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-6401
Country	:	US
Telephone Number	:	719-473-6677
Fax Number	:	719-473-9219

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. JOHN ROBERT SWENSON
Credential	:	DPM
Telephone Number	:	719-473-6677

Provider Enumeration Date	:	12/09/2007
Last Update Date	:	11/30/2010

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