Provider Demographics
NPI:1952846321
Name:SWFAC PLC
Entity Type:Organization
Organization Name:SWFAC PLC
Other - Org Name:SOUTHWEST FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:STANISLAV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:712-623-5178
Mailing Address - Street 1:502 E REED ST.
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566
Mailing Address - Country:US
Mailing Address - Phone:712-623-5178
Mailing Address - Fax:712-623-2703
Practice Address - Street 1:631 N. 8TH ST.
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555
Practice Address - Country:US
Practice Address - Phone:800-334-5516
Practice Address - Fax:712-623-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty