Provider Demographics
NPI:1326250499
Name:MINA SWOFFORD, M.D. P.C
Entity Type:Organization
Organization Name:MINA SWOFFORD, M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWOFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-683-3160
Mailing Address - Street 1:2101 JACKSON STR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4386
Mailing Address - Country:US
Mailing Address - Phone:765-683-3160
Mailing Address - Fax:765-646-8367
Practice Address - Street 1:2101 JACKSON STR
Practice Address - Street 2:SUITE 118
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4386
Practice Address - Country:US
Practice Address - Phone:765-683-3160
Practice Address - Fax:765-646-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042478207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200806160AMedicaid
IN200806160AMedicaid
INE58352Medicare UPIN