Basic Information
| Provider Information | |||||||||
| NPI: | 1588670178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWARTZ | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 DOCTORS PARK | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733346071 | ||||||||
| FaxNumber: | 5733344739 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 DOCTORS PARK | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733346071 | ||||||||
| FaxNumber: | 5733344739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2000175096 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 063896 | 01 | HEALTH ALLIANCE | OTHER | 185214 | 01 | MO | MO BLUE CROSS BLUE SHIELD | OTHER | 205190101 | 05 | MO | MEDICAID | 143816001 | 05 | AR | MEDICAID | 430954380CAP | 01 | MERCY HEALTH PLAN | OTHER | 036-106139 | 01 | IL | IL BLUE CROSS BLUE SHIELD | OTHER | 455991 | 01 | HEALTHLINK | OTHER |