Healthcare Provider Details

I. General information

NPI: 1497854970
Provider Name (Legal Business Name): MINNEE SWICEGOOD BYRD RT(R)(ARRT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KIMEL PARK DRIVE VA OUTPATIENT CLINIC
WINSTON-SALEM NC
27103-6946
US

IV. Provider business mailing address

273 HOLLIS DR
LEXINGTON NC
27295-7035
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3296
  • Fax: 336-760-5481
Mailing address:
  • Phone: 336-731-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number310916
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: