Provider Demographics
NPI:1407153539
Name:JAMES L. SWINGLER M.D. GYNECOLOGY & OBSTETRICS S.C.
Entity Type:Organization
Organization Name:JAMES L. SWINGLER M.D. GYNECOLOGY & OBSTETRICS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SWINGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-692-0128
Mailing Address - Street 1:7501 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1222
Mailing Address - Country:US
Mailing Address - Phone:309-692-0128
Mailing Address - Fax:309-692-0193
Practice Address - Street 1:7501 N UNIVERSITY ST
Practice Address - Street 2:SUITE 113
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1222
Practice Address - Country:US
Practice Address - Phone:309-692-0128
Practice Address - Fax:309-692-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062855207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7228140OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL036062855Medicaid
IL7228140OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL200721Medicare PIN