Swartzentruber Medical Services LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

63965 Issued in GA

Legal business name

SWARTZENTRUBER MEDICAL SERVICES LLC

Practice address

440 Paul Murphy Rd
Moultrie, GA 31768-0428

Phone

(229) 891-5308

NPI assigned

Mar 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary W Swartzentruber, MDNPI 1083937908

Title

Owner

Phone

(229) 891-5308

Specialties & licenses 1

Addresses

Other names 1

• SWARTZENTRUBER MEDICAL SERVICES LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Wade Swartzentruber, MD

  • Family Medicine Physician
  • Moultrie, GA
  • NPI 1083937908

  Family Medicine, GA

  Medicare reassignment Care Compare group NPD Authorized official
• Heather G Dismuke, FNP-BC

  • Family Nurse Practitioner
  • Moultrie, GA
  • NPI 1386320752

  GA

  Medicare reassignment Care Compare group NPD
• Tiffanie Gibson

  • Family Nurse Practitioner
  • Moultrie, GA
  • NPI 1962881359

  GA

  Medicare reassignment Care Compare group NPD
• William David Houston, FNP-C

  • Family Nurse Practitioner
  • Moultrie, GA
  • NPI 1861119869

  GA

  Medicare reassignment Care Compare group NPD
• Sean C Sauls, P.A.

  • Medical Physician Assistant
  • Moultrie, GA
  • NPI 1407963952

  GA

  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638144000000",
    "number": "1376904201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760012",
            "telephone_number": "229-891-5308",
            "fax_number": "229-616-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 PAUL MURPHY RD",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317680428",
            "telephone_number": "229-891-5308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWARTZENTRUBER MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-20",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "SWARTZENTRUBER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-891-5308",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "63965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SWARTZENTRUBER MEDICAL SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SWARTZENTRUBER MEDICAL SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Lee Stroh, OT
• Ebony D Stubbins, FNP
• Mailyn Suarez
• Sunack Dialysis, LLC
• Surgical Associates of South Georgia, P.C.
• Gary Wade Swartzentruber, MD
• Tail Winds Residential, LLC
• Amanda Taylor, RN
• Janae Ashanti Taylor
• Michael A Thayer, M.D.

• All providers in Moultrie, GA
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.