Provider Demographics
NPI:1699346270
Name:SWAHN BALANCED HEALTH
Entity type:Organization
Organization Name:SWAHN BALANCED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, INFUSION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SWAHN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:801-390-4972
Mailing Address - Street 1:2267 S 2775 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7095
Mailing Address - Country:US
Mailing Address - Phone:801-390-4972
Mailing Address - Fax:
Practice Address - Street 1:1013 W 2700 S
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8973
Practice Address - Country:US
Practice Address - Phone:801-613-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center