Provider Demographics
NPI:1992909030
Name:LANE SWAYZE CLINIC, P.C.
Entity type:Organization
Organization Name:LANE SWAYZE CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-798-3938
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:209 S. MAIN STREET
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-0445
Mailing Address - Country:US
Mailing Address - Phone:810-798-3938
Mailing Address - Fax:810-798-8870
Practice Address - Street 1:209 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003
Practice Address - Country:US
Practice Address - Phone:810-798-3938
Practice Address - Fax:810-798-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL004855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1688080Medicaid
MIMI2292Medicare PIN
MIE26619Medicare UPIN