Provider Demographics
NPI:1740317197
Name:SWANSBORO MEDICAL CENTER, PA
Entity type:Organization
Organization Name:SWANSBORO MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-326-5588
Mailing Address - Street 1:718 W CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8452
Mailing Address - Country:US
Mailing Address - Phone:910-326-5588
Mailing Address - Fax:910-326-6923
Practice Address - Street 1:718 W CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8452
Practice Address - Country:US
Practice Address - Phone:910-326-5588
Practice Address - Fax:910-326-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2804615OtherCIGNA MEDICARE
NC0130ROtherBCBSNC
NC343972AMedicaid
NCE0124OtherMEDCOST
NC343972Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC