=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144819012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWIFT EMERGENCY CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2021
-----------------------------------------------------
Last Update Date | 01/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 182-50 ROCKAWAY BLVD
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11434-1007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-771-5903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 E 79TH ST APT 2B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10075-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-771-5903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CHRISTIAN BANNERMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-771-5903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------