Provider Demographics
NPI:1932565694
Name:SWACK MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SWACK MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SWACKHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-988-9674
Mailing Address - Street 1:2400 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1789
Mailing Address - Country:US
Mailing Address - Phone:919-988-9674
Mailing Address - Fax:919-988-9676
Practice Address - Street 1:2400 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1789
Practice Address - Country:US
Practice Address - Phone:724-691-7912
Practice Address - Fax:919-988-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF488Medicare PIN