Healthcare Provider Details
I. General information
NPI: 1356334262
Provider Name (Legal Business Name): SWIFT'S CRITICAL CARE NETWORK FOR CHILDREN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US
IV. Provider business mailing address
3006 S MARYLAND PKWY 505
LAS VEGAS NV
89109-2218
US
V. Phone/Fax
- Phone: 888-350-2911
- Fax: 702-369-5827
- Phone: 702-697-0082
- Fax: 702-369-5827
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080P0203X |
| Taxonomy | Pediatric Critical Care Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JAMES
D
SWIFT
Title or Position: OWNER/DIRECTOF
Credential: M.D.
Phone: 702-697-0082