Provider Demographics
NPI:1659592517
Name:SWAMY CLINIC PA
Entity Type:Organization
Organization Name:SWAMY CLINIC PA
Other - Org Name:PLASTIC SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PONNUSWAMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-893-6311
Mailing Address - Street 1:1111 SARA SWAMY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1779
Mailing Address - Country:US
Mailing Address - Phone:903-893-6311
Mailing Address - Fax:903-870-0456
Practice Address - Street 1:1111 SARA SWAMY DR
Practice Address - Street 2:SUITE A
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1779
Practice Address - Country:US
Practice Address - Phone:903-893-6311
Practice Address - Fax:903-870-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U73QMedicare ID - Type Unspecified