Basic Information
| Provider Information | |||||||||
| NPI: | 1750319935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWEAZY | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037968515 | ||||||||
| FaxNumber: | 8037968516 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 WEST HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037968515 | ||||||||
| FaxNumber: | 8037968516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 02/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 18292 | SC | N | Other Service Providers | Specialist | 208800000X | 21-8292 | SC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | T22071 | 05 | SC | MEDICAID |