Healthcare Provider Details

I. General information

NPI: 1346246204
Provider Name (Legal Business Name): GENE A SWEDE BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E 2ND ST
REDWOOD FALLS MN
56283-1601
US

IV. Provider business mailing address

109 E 2ND ST
REDWOOD FALLS MN
56283-1601
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-3021
  • Fax: 507-637-2321
Mailing address:
  • Phone: 507-637-3021
  • Fax: 507-637-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2004
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: