Provider Demographics
NPI:1871674515
Name:LAWRENCE C. SWAN, M.D.
Entity Type:Organization
Organization Name:LAWRENCE C. SWAN, M.D.
Other - Org Name:COVENANT FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-339-1760
Mailing Address - Street 1:2620 WESTSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3605
Mailing Address - Country:US
Mailing Address - Phone:423-339-1760
Mailing Address - Fax:423-559-1483
Practice Address - Street 1:2620 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3605
Practice Address - Country:US
Practice Address - Phone:423-339-1760
Practice Address - Fax:423-559-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032152OtherMEDICARE IND- SWAN
TNG62659OtherUPIN - SIMS
TN0078692OtherBCBST GROUP
TN245331943OtherTRICARE - SIMS INDIVIDUAL
TN3032152OtherMEDICAID - SWAN
TN4052544OtherBCBST IND - SIMS
TN44D0309375OtherCLIA - GROUP
TNA99578OtherUPIN - SWAN
TN0078692OtherBCBST IND - SWAN
TN3719860OtherMEDICARE GROUP
TN3880829OtherMEDICAID - SIMS
TN1584772OtherGHI - SIMS
TN272525633OtherTRICARE - SWAN INDIVIDUAL
TN3880829OtherMEDICARE IND - SIMS
TN1584771OtherGHI - SWAN
TN0078692OtherBCBST GROUP
TN4052544OtherBCBST IND - SIMS