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General NPI Number Information
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NPI Number | 1740317197
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Entity Type | Organization
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Legal Business Name | SWANSBORO MEDICAL CENTER, PA
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 718 W CORBETT AVE
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City | SWANSBORO
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State | NC
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Zip | 28584-8452
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Country | US
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Telephone | 910-326-5588
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Fax | 910-326-6923
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Provider Business Mailing Address
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Address Line | 718 W CORBETT AVE
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City | SWANSBORO
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State | NC
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Zip | 28584-8452
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Country | US
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Telephone | 910-326-5588
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Fax | 910-326-6923
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. DENNIS MICHAEL MAHAN
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Credential | M.D.
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Telephone | 910-326-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66693
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License Number State | NC
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