Provider Demographics
NPI:1154681112
Name:CASWELL ORTHOPEDIC CLINIC
Entity Type:Organization
Organization Name:CASWELL ORTHOPEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-580-4217
Mailing Address - Street 1:516 JEFFERSON TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4980
Mailing Address - Country:US
Mailing Address - Phone:866-580-4217
Mailing Address - Fax:
Practice Address - Street 1:516 JEFFERSON TER
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4980
Practice Address - Country:US
Practice Address - Phone:866-580-4217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty