MEDICARE: SCW MEDICAL PLLC

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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1720672058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCW MEDICAL PLLC

Provider Business Mailing Address
First Line	:	3443 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1181
Country	:	US
Telephone Number	:	610-678-8600
Fax Number	:	610-678-4747

Provider Business Practice Location Address
First Line	:	3443 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1181
Country	:	US
Telephone Number	:	610-678-8600
Fax Number	:	610-678-4747

Authorized Official
Title or Position	:	OWNER
Name	:	TRISTAN ADAM SMITH
Credential	:	DC
Telephone Number	:	610-763-5251

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	02/26/2021

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