Provider Demographics
NPI:1487757571
Name:OLD TOWN FAMILY PRACTICE PA
Entity type:Organization
Organization Name:OLD TOWN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWALDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-393-4726
Mailing Address - Street 1:413 W. BETHEL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4402
Mailing Address - Country:US
Mailing Address - Phone:972-393-4726
Mailing Address - Fax:972-393-4850
Practice Address - Street 1:413 W. BETHEL RD
Practice Address - Street 2:STE 300
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4402
Practice Address - Country:US
Practice Address - Phone:972-393-4726
Practice Address - Fax:972-393-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X036Medicare PIN
TXG13139Medicare UPIN