Provider Demographics
NPI:1457995482
Name:HOWARD STELLY LLC
Entity Type:Organization
Organization Name:HOWARD STELLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-309-3404
Mailing Address - Street 1:4810 TAIMER ST STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 W SALE RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2400
Practice Address - Country:US
Practice Address - Phone:337-477-6061
Practice Address - Fax:337-474-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191770Medicaid