Provider Demographics
NPI:1235100801
Name:MCSWAIN, CHARLES HENRY (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:MCSWAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:H
Other - Last Name:MCSWAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 777923
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
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 1:2225 E FLAMINGO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5125
Practice Address - Country:US
Practice Address - Phone:702-419-7529
Practice Address - Fax:702-538-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002837Medicaid
D30210Medicare UPIN
01WCHKL30Medicare Oscar/Certification
NV01WCHKL30Medicare PIN
NVBV404XMedicare PIN