Provider Demographics
NPI:1477737815
Name:T M SWINGER & D V MCKILLIP, PTR
Entity Type:Organization
Organization Name:T M SWINGER & D V MCKILLIP, PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-333-1860
Mailing Address - Street 1:214 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2053
Mailing Address - Country:US
Mailing Address - Phone:573-888-6718
Mailing Address - Fax:
Practice Address - Street 1:214 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2053
Practice Address - Country:US
Practice Address - Phone:573-888-6718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310150404Medicaid
MO410027250OtherRAILROAD MEDICARE
MO0279400002OtherNSC MEDICARE
MO310150404Medicaid
MO410027250OtherRAILROAD MEDICARE