| Swartzentruber Medical Services Llc | |
|
440 Paul Murphy Rd Moultrie GA 31768-0428 | |
| (229) 891-5308 | |
| Not Available |
| Full Name | Swartzentruber Medical Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 440 Paul Murphy Rd, Moultrie, Georgia |
| Authorized Official Name and Position | Gary W Swartzentruber (OWNER) |
| Authorized Official Contact | 2298915308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Swartzentruber Medical Services Llc Po Box 12 Moultrie GA 31776-0012 Ph: (229) 891-5308 | Swartzentruber Medical Services Llc 440 Paul Murphy Rd Moultrie GA 31768-0428 Ph: (229) 891-5308 |
| NPI Number | 1376904201 |
|---|---|
| Provider Enumeration Date | 03/20/2016 |
| Last Update Date | 11/29/2021 |
| Medicare PECOS PAC ID | 9537458815 |
|---|---|
| Medicare Enrollment ID | O20160511000213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376904201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 63965 (Georgia) | Primary |
| Provider Name | Gary W Swartzentruber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083937908 PECOS PAC ID: 7719016575 Enrollment ID: I20100603000832 |
| Provider Name | Tiffanie Ann Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962881359 PECOS PAC ID: 9638480379 Enrollment ID: I20150622001037 |
| Provider Name | Casey Jo Bennett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144680034 PECOS PAC ID: 8628362068 Enrollment ID: I20160809000682 |
| Provider Name | Heather G Dismuke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386320752 PECOS PAC ID: 7618336140 Enrollment ID: I20230630002707 |
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