Provider Demographics
NPI:1104958719
Name:SWINK, BEN W (DO)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:W
Last Name:SWINK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8710 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2724
Mailing Address - Country:US
Mailing Address - Phone:314-961-3570
Mailing Address - Fax:314-961-6450
Practice Address - Street 1:8710 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-961-3570
Practice Address - Fax:314-961-6450
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO115255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208746800Medicaid
MO933811753Medicare PIN
MO208746800Medicaid