MEDICARE: SWAN DIALYSIS SERVICES, LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1922195114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWAN DIALYSIS SERVICES, LLC

Provider Business Mailing Address
First Line	:	930 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9390
Country	:	US
Telephone Number	:	410-773-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4205
Country	:	US
Telephone Number	:	702-396-0220
Fax Number	:	702-396-8640

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHLEEN SWANN
Credential	:
Telephone Number	:	702-396-0220

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	08/22/2020

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