Provider Demographics
NPI:1134491814
Name:SWAN UROGYNECOLOGY PC
Entity Type:Organization
Organization Name:SWAN UROGYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-515-9180
Mailing Address - Street 1:329 21ST AVE N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1839
Mailing Address - Country:US
Mailing Address - Phone:615-515-9180
Mailing Address - Fax:615-712-7647
Practice Address - Street 1:801 HILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2951
Practice Address - Country:US
Practice Address - Phone:615-515-9180
Practice Address - Fax:615-712-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029235261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty