Healthcare Provider Details

I. General information

NPI: 1740317197
Provider Name (Legal Business Name): SWANSBORO MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 W CORBETT AVE
SWANSBORO NC
28584-8452
US

IV. Provider business mailing address

718 W CORBETT AVE
SWANSBORO NC
28584-8452
US

V. Phone/Fax

Practice location:
  • Phone: 910-326-5588
  • Fax: 910-326-6923
Mailing address:
  • Phone: 910-326-5588
  • Fax: 910-326-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66693
License Number StateNC

VIII. Authorized Official

Name: DR. DENNIS MICHAEL MAHAN
Title or Position: CLINIC DIRECTOR
Credential: M.D.
Phone: 910-326-5588