Healthcare Provider Details

I. General information

NPI: 1568578870
Provider Name (Legal Business Name): KATHERINE K SWANK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 BELTLINE RD
SPRINGFIELD OR
97477-1091
US

IV. Provider business mailing address

5901 HARPER DR NE PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87109-3587
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6005
  • Fax: 541-222-6029
Mailing address:
  • Phone: 505-823-8528
  • Fax: 505-823-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPS2005-0480
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD27496
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: