Provider Demographics
NPI:1821083387
Name:SWIFTS CRITICAL CARE NETWORK FOR CHILDREN MEDICAL GROUP
Entity Type:Organization
Organization Name:SWIFTS CRITICAL CARE NETWORK FOR CHILDREN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-350-2911
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:#505
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:888-350-2911
Mailing Address - Fax:702-369-5827
Practice Address - Street 1:18321 CLARK ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3501
Practice Address - Country:US
Practice Address - Phone:888-350-2911
Practice Address - Fax:702-369-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084493Medicaid
CAGR0084493Medicaid