MEDICARE: CS PACS 3 SOUTHEAST, 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
1	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1154104958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CS PACS 3 SOUTHEAST, LLC

Provider Business Mailing Address
First Line	:	1643 NW 136TH AVE STE 100
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2857
Country	:	US
Telephone Number	:	865-500-1325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 BLAND ST
Second Line	:
City	:	BLUEFIELD
State	:	WV
Zip	:	24701-3775
Country	:	US
Telephone Number	:	304-327-2485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DARREN SWENSON
Credential	:
Telephone Number	:	865-693-1000

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	04/21/2026

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