Healthcare Provider Details

I. General information

NPI: 1336896216
Provider Name (Legal Business Name): MR. JAMES LUTHER SWARTZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S MARION ST
LAKE CITY FL
32025-5898
US

IV. Provider business mailing address

619 S MARION AVE
LAKE CITY FL
32025-5808
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax:
Mailing address:
  • Phone: 352-318-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: