=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083615801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JIMMY D. SWANSON, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 08/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 272 BIELBY RD
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47025-1056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-537-8402
-----------------------------------------------------
Fax | 812-537-8425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4105
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47025-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-537-8402
-----------------------------------------------------
Fax | 812-537-8425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JIMMY D SWANSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 812-537-8402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 35-05-3520-S
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 01037561
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------