Provider Demographics
NPI:1376929901
Name:SW MEDIACAL INC
Entity Type:Organization
Organization Name:SW MEDIACAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:METALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-594-8380
Mailing Address - Street 1:2561 PASS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2125
Mailing Address - Country:US
Mailing Address - Phone:228-594-8380
Mailing Address - Fax:228-594-8393
Practice Address - Street 1:2561 PASS RD
Practice Address - Street 2:SUITE D
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2125
Practice Address - Country:US
Practice Address - Phone:228-594-8380
Practice Address - Fax:228-594-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS097339152W00000X
MS207QA0401X
MS239412084A0401X
MSR791344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1255343570Medicare UPIN
MS1699738823Medicare PIN
MS1639248099Medicare UPIN