Healthcare Provider Details

I. General information

NPI: 1801233879
Provider Name (Legal Business Name): SWC MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8346 KELWOOD AVE
BATON ROUGE LA
70806-4803
US

IV. Provider business mailing address

8346 KELWOOD AVE
BATON ROUGE LA
70806-4803
US

V. Phone/Fax

Practice location:
  • Phone: 225-400-9004
  • Fax: 225-810-3111
Mailing address:
  • Phone: 225-400-9004
  • Fax: 225-810-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PARKER SILVA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 225-400-9004