Healthcare Provider Details

I. General information

NPI: 1952846321
Provider Name (Legal Business Name): SWFAC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N. 8TH ST.
MISSOURI VALLEY IA
51555
US

IV. Provider business mailing address

502 E REED ST.
RED OAK IA
51566
US

V. Phone/Fax

Practice location:
  • Phone: 800-334-5516
  • Fax: 712-623-2703
Mailing address:
  • Phone: 712-623-5178
  • Fax: 712-623-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW C STANISLAV
Title or Position: OWNER
Credential: DPM
Phone: 712-623-5178