MEDICARE: KENT SWAINE MD PC

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	207Q00000X	Family Medicine Physician	9815	NV

General Provider Information

NPI Number	:	1154354207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT SWAINE MD PC

Provider Business Mailing Address
First Line	:	PO BOX 36670
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6670
Country	:	US
Telephone Number	:	702-407-8241
Fax Number	:	702-492-1728

Provider Business Practice Location Address
First Line	:	2610 W HORIZON RIDGE PKWY
Second Line	:	SUITE #103
City	:	HENDERSON
State	:	NV
Zip	:	89052-2869
Country	:	US
Telephone Number	:	702-407-8241
Fax Number	:	702-492-1728

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENT ALAN SWAINE
Credential	:	M.D.
Telephone Number	:	702-596-2080

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/12/2007

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