Provider Demographics
NPI:1376904201
Name:SWARTZENTRUBER MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:SWARTZENTRUBER MEDICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SWARTZENTRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-891-5308
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-0012
Mailing Address - Country:US
Mailing Address - Phone:229-891-5308
Mailing Address - Fax:229-616-1165
Practice Address - Street 1:440 PAUL MURPHY RD
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-0428
Practice Address - Country:US
Practice Address - Phone:229-891-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty