=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780947846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD C SWEDARSKY D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2012
-----------------------------------------------------
Last Update Date | 01/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-5445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1061 HARMON AVE SUITE 1D03
-----------------------------------------------------
City | FORT STEWART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31314-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-435-6633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 1049
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------