Provider Demographics
NPI:1497714125
Name:SWIFT CREEK CHILDREN'S HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:SWIFT CREEK CHILDREN'S HEALTHCARE CORPORATION
Other - Org Name:SWIFT CREEK PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-378-4420
Mailing Address - Street 1:13700 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-378-4420
Mailing Address - Fax:804-378-4440
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-378-4420
Practice Address - Fax:804-378-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09185OtherMEDICARE GROUP NUMBER
VA1700855624OtherDR. CANTOR NPI
VA1417906801OtherDR. BANTLE NPI