Provider Demographics
NPI:1033453774
Name:CHARLES J, ASWELL III MD A PROF MEDICAL CORP
Entity Type:Organization
Organization Name:CHARLES J, ASWELL III MD A PROF MEDICAL CORP
Other - Org Name:ASWELL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-7474
Mailing Address - Street 1:503 JACK MILLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5607
Mailing Address - Country:US
Mailing Address - Phone:337-363-7474
Mailing Address - Fax:
Practice Address - Street 1:503 JACK MILLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5607
Practice Address - Country:US
Practice Address - Phone:337-363-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health