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NPI Code Detail

MEDICARE: MIKE SWAIM VAN SWAIM CASEY VERNON

MEDICARE: MIKE SWAIM VAN SWAIM CASEY VERNON
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
1333600000XPharmacy311TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568437945
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIKE SWAIM VAN SWAIM CASEY VERNON
Provider Business Mailing Address
First Line : 1325 E WOOD ST
Second Line :
City : PARIS
State : TN
Zip : 38242-4421
Country : US
Telephone Number : 731-642-0451
Fax Number : 731-642-4034
Provider Business Practice Location Address
First Line : 1325 E WOOD ST
Second Line :
City : PARIS
State : TN
Zip : 38242-4421
Country : US
Telephone Number : 731-642-0451
Fax Number : 731-642-4034
Authorized Official
Title or Position : PIC/OWNER
Name : MR. MAC CASEY VERNON
Credential : DPH
Telephone Number : 731-642-0451
Provider Enumeration Date : 02/21/2006
Last Update Date : 04/07/2015

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