Provider Demographics
NPI:1043442445
Name:SWANSON, MATTHEW A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 N SAINT FRANCIS ST
Mailing Address - Street 2:STE 130
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2878
Mailing Address - Country:US
Mailing Address - Phone:316-264-3505
Mailing Address - Fax:316-264-0908
Practice Address - Street 1:1100 N SAINT FRANCIS ST
Practice Address - Street 2:STE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2878
Practice Address - Country:US
Practice Address - Phone:316-264-3505
Practice Address - Fax:316-264-0908
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200616940AMedicaid
KS200616940AMedicaid