Provider Demographics
NPI:1083615801
Name:JIMMY D. SWANSON, MD, INC.
Entity Type:Organization
Organization Name:JIMMY D. SWANSON, MD, INC.
Other - Org Name:SWANSON ORTHOPAEDIC SURGERY AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-537-8402
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-4105
Mailing Address - Country:US
Mailing Address - Phone:812-537-8402
Mailing Address - Fax:812-537-8425
Practice Address - Street 1:272 BIELBY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1056
Practice Address - Country:US
Practice Address - Phone:812-537-8402
Practice Address - Fax:812-537-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037561207X00000X
OH35-05-3520-S207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0251123-003OtherCIGNA RENDERING #
645223OtherAETNA RENDERING #
010025828OtherRAILROAD MEDICARE #
000000014822OtherBLUE SHIELD INDIANA #
53520OtherCHOICE CARE RENDERING #
0901330OtherUNITED HEALTH CARE
IN100017200AMedicaid
124097500OtherDEPT OF LABOR PIN
=========001OtherTRI-CARD PIN
53520OtherCHOICE CARE RENDERING #
0901330OtherUNITED HEALTH CARE
124097500OtherDEPT OF LABOR PIN
=========-00OtherBWC RENDERING #
IN171770AMedicare PIN
0251123-003OtherCIGNA RENDERING #
124097500OtherDEPT OF LABOR PIN