Provider Demographics
NPI:1285816850
Name:RUSSELL E SWANN M.D. PA
Entity Type:Organization
Organization Name:RUSSELL E SWANN M.D. PA
Other - Org Name:BRAZOS EYE SURGERY OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SHAYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-772-4499
Mailing Address - Street 1:201 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7902
Mailing Address - Country:US
Mailing Address - Phone:254-772-4499
Mailing Address - Fax:254-772-4436
Practice Address - Street 1:201 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7902
Practice Address - Country:US
Practice Address - Phone:254-772-4499
Practice Address - Fax:254-772-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5626207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619130895OtherNPI
TXDC9834OtherRR MEDICARE PIN
TX085656902Medicaid
TX1477717759OtherNPI
1841293016OtherNPI
TX1073518072OtherNPI
TX1477717759OtherNPI
TX0477270001Medicare NSC
TX=========OtherTAX ID
TXDC9834OtherRR MEDICARE PIN