MEDICARE: TRAVIS JAY SWIFT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	0010-03061	NC
2	363AS0400X	Surgical Physician Assistant	5419926-1206	UT
3	363AS0400X	Surgical Physician Assistant	5153	AZ

General Provider Information

NPI Number	:	1053691238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS JAY SWIFT PA-C

Provider Business Mailing Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	01/25/2018

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Directions to “ TRAVIS JAY SWIFT PA-C” Practice Location

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