Basic Information
Provider Information | |||||||||
NPI: | 1770685331 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SWARTWOOD | ||||||||
FirstName: | LESTER | ||||||||
MiddleName: | DAVID | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SWARTWOOD | ||||||||
OtherFirstName: | L. | ||||||||
OtherMiddleName: | DAVID | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 4000 CENTRAL AVE NE | ||||||||
Address2: |   | ||||||||
City: | COLUMBIA HEIGHTS | ||||||||
State: | MN | ||||||||
PostalCode: | 554212968 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7637828100 | ||||||||
Practice Location | |||||||||
Address1: | 4000 CENTRAL AVE NE | ||||||||
Address2: |   | ||||||||
City: | COLUMBIA HEIGHTS | ||||||||
State: | MN | ||||||||
PostalCode: | 554212968 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635725710 | ||||||||
FaxNumber: | 7637828100 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/03/2006 | ||||||||
LastUpdateDate: | 04/05/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25402 | MN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 370705900 | 05 | MN |   | MEDICAID | 0403899 | 01 | MN | MEDICA | OTHER | 1000896 | 01 | MN | PREFERRED ONE | OTHER | 107322 | 01 | MN | UCARE MN | OTHER | 22530 | 01 | MN | AMERICA'S PPO | OTHER | 6607196 | 01 | MN | MEDICA URGENT CARE | OTHER | HP19922 | 01 | MN | HEALTHPARTNERS | OTHER | 09F06SW | 01 | MN | BCBS OF MN | OTHER | 4125367 | 01 | MN | AETNA INS | OTHER |