Basic Information
Provider Information
NPI: 1538813076
EntityType: 2
ReplacementNPI:  
OrganizationName: RICKY SWAIM PLLC
LastName:  
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Mailing Information
Address1: 3412 NW 166TH CT
Address2:  
City: EDMOND
State: OK
PostalCode: 730120606
CountryCode: US
TelephoneNumber: 4059423737
FaxNumber: 4059423873
Practice Location
Address1: 700 NW 7TH ST
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731021212
CountryCode: US
TelephoneNumber: 4059423737
FaxNumber: 4059423873
Other Information
ProviderEnumerationDate: 02/03/2022
LastUpdateDate: 03/28/2022
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SWAIM
AuthorizedOfficialFirstName: RICKY
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4059423737
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate: 03/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193400000X MULTIPLE SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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