| Organization Name: | CHARLES J, ASWELL III MD A PROF MEDICAL CORP |
| NPI Number: | 1033453774 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SELENA DUTTON (PRACTICE ADMINISTRATOR) |
| Mailing Address: | 503 Jack Miller Rd Suite A Ville Platte |
| State: | LA US |
| Postal Code: | 705865607 |
| Phone Number: | 3373637474 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2012 |
| NPI Last Update Date: | 10/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |