Provider Demographics
NPI:1669013793
Name:SWAGATH LLC
Entity type:Organization
Organization Name:SWAGATH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRAVALLIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-225-2098
Mailing Address - Street 1:5107 MEDICAL DR
Mailing Address - Street 2:STE #202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:409-225-2098
Mailing Address - Fax:877-701-9241
Practice Address - Street 1:5107 MEDICAL DR
Practice Address - Street 2:STE #202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:409-225-2098
Practice Address - Fax:877-701-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150130Medicaid