MEDICARE: SWING CARE PROVIDER GROUP 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548116296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWING CARE PROVIDER GROUP PC

Provider Business Mailing Address
First Line	:	440 N BARRANCA AVE # 1801
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1722
Country	:	US
Telephone Number	:	800-924-7811
Fax Number	:	877-349-1868

Provider Business Practice Location Address
First Line	:	200 W MONROE ST OFC 203
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85003-1740
Country	:	US
Telephone Number	:	800-924-7811
Fax Number	:	877-349-1868

Authorized Official
Title or Position	:	SR. REVENUE CYCLE MANAGER
Name	:	SEAN MARTINEZ
Credential	:
Telephone Number	:	262-667-7326

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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