Provider Demographics
NPI:1164753851
Name:CHARLES H MCSWAIN DO PC
Entity Type:Organization
Organization Name:CHARLES H MCSWAIN DO PC
Other - Org Name:MCSWAIN FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MCSWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-419-7529
Mailing Address - Street 1:P. O. BOX 777923
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89077
Mailing Address - Country:US
Mailing Address - Phone:702-419-7529
Mailing Address - Fax:702-538-8151
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:SUITE F-1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-419-7529
Practice Address - Fax:702-538-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002837Medicaid
NVD30210Medicare UPIN
NV2002837Medicaid