MEDICARE: MR. CHRIS LEE MCSWAIN 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	363A00000X	Physician Assistant	103488	NC

General Provider Information

NPI Number	:	1528020286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS LEE MCSWAIN PA-C

Provider Business Mailing Address
First Line	:	1234 WATERFORD CT
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-3921
Country	:	US
Telephone Number	:	903-316-2287
Fax Number	:

Provider Business Practice Location Address
First Line	:	USAMEDDAC # 63
Second Line	:
City	:	FT POLK
State	:	LA
Zip	:	71459
Country	:	US
Telephone Number	:	337-531-3495
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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