=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841431236
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS SWISSHELM MED, EDS, BCN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2009
-----------------------------------------------------
Last Update Date | 01/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2180 A1A S STE 100
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-6523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-514-7143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2180 A1A S STE 100
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32080-6523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-514-7143
-----------------------------------------------------
Fax | 904-758-5401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0500X
-----------------------------------------------------
Taxonomy Name | EEG Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------