Provider Demographics
NPI:1730662313
Name:SWIMBIKUSRUN
Entity Type:Organization
Organization Name:SWIMBIKUSRUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-218-6966
Mailing Address - Street 1:1529 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-4850
Mailing Address - Country:US
Mailing Address - Phone:402-218-6966
Mailing Address - Fax:
Practice Address - Street 1:1529 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-4850
Practice Address - Country:US
Practice Address - Phone:402-218-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service