Provider Demographics
NPI:1093745242
Name:GREGORY A SWAIM LLC
Entity Type:Organization
Organization Name:GREGORY A SWAIM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-294-7444
Mailing Address - Street 1:6723 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223-1253
Mailing Address - Country:US
Mailing Address - Phone:877-294-7444
Mailing Address - Fax:
Practice Address - Street 1:9440 POPPY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3652
Practice Address - Country:US
Practice Address - Phone:817-294-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89002246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty