Provider Demographics
NPI:1649315029
Name:SWENSON MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SWENSON MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-842-2062
Mailing Address - Street 1:1501 S OREGON ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3425
Mailing Address - Country:US
Mailing Address - Phone:530-842-2062
Mailing Address - Fax:530-842-2160
Practice Address - Street 1:1501 S OREGON ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3425
Practice Address - Country:US
Practice Address - Phone:530-842-2062
Practice Address - Fax:530-842-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care