Provider Demographics
NPI:1760655732
Name:STEVEN H SWEDBERG MD PS
Entity Type:Organization
Organization Name:STEVEN H SWEDBERG MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SWEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-778-2500
Mailing Address - Street 1:21827 76TH AVE W
Mailing Address - Street 2:STE 102
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7981
Mailing Address - Country:US
Mailing Address - Phone:425-778-2500
Mailing Address - Fax:425-778-5600
Practice Address - Street 1:21827 76TH AVE W
Practice Address - Street 2:STE 102
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7981
Practice Address - Country:US
Practice Address - Phone:425-778-2500
Practice Address - Fax:425-778-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00033003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109887Medicaid
WA4466240001Medicare NSC
WAG44095Medicare UPIN
WA7109887Medicaid