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NPI Code Detail

MEDICARE: SWCC, INC.

MEDICARE: SWCC, INC.
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
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1205116985
Entity Type Code : Organization
Provider Name (Legal Business Name) : SWCC, INC.
Provider Business Mailing Address
First Line : 2980 N BEVERLY GLEN CIR
Second Line : SUITE 301
City : LOS ANGELES
State : CA
Zip : 90077-1726
Country : US
Telephone Number : 310-474-9809
Fax Number :
Provider Business Practice Location Address
First Line : 3802 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-3112
Country : US
Telephone Number : 702-313-8446
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DONALD TICE
Credential : D.O.
Telephone Number : 702-313-8446
Provider Enumeration Date : 08/25/2011
Last Update Date : 08/25/2011

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Directions to “SWCC, INC. ” Practice Location

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