MEDICARE: SWORDFISH HEALTHCARE

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	261QX0100X	Occupational Medicine Clinic/Center	PA01304	TX

General Provider Information

NPI Number	:	1639506561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWORDFISH HEALTHCARE

Provider Business Mailing Address
First Line	:	4304 APACHE CT
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-3501
Country	:	US
Telephone Number	:	979-709-8361
Fax Number	:

Provider Business Practice Location Address
First Line	:	6051 DAVIS BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76182-5401
Country	:	US
Telephone Number	:	866-229-5066
Fax Number	:

Authorized Official
Title or Position	:	RECRUITER
Name	:	MR. GREG MCCULLOUGH
Credential	:
Telephone Number	:	832-685-4424

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	10/09/2013

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Directions to “SWORDFISH HEALTHCARE ” Practice Location

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