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NPI Code Detail

MEDICARE: GREGORY A SWAIM LLC

MEDICARE: GREGORY A SWAIM LLC
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
1246ZS0410XSurgical Technologist89002TX

General Provider Information

NPI Number : 1093745242
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREGORY A SWAIM LLC
Provider Business Mailing Address
First Line : 6723 SANTA FE AVE
Second Line :
City : DALLAS
State : TX
Zip : 75223-1253
Country : US
Telephone Number : 877-294-7444
Fax Number :
Provider Business Practice Location Address
First Line : 9440 POPPY DR
Second Line :
City : DALLAS
State : TX
Zip : 75218-3652
Country : US
Telephone Number : 817-294-7444
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GREGORY SWAIM
Credential :
Telephone Number : 877-294-7444
Provider Enumeration Date : 07/04/2006
Last Update Date : 08/22/2020

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