Organization
AGAPE EAR NOSE & THROAT CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN KENNETH SEWELL M.D. (PHYSICIAN)
(337) 392-1000
Entity
Organization
Contact information
Practice address
1608 S 5TH ST, LEESVILLE, LA 71446-5304
(337) 392-1000
(337) 392-1099
Mailing address
1608 S 5TH ST, LEESVILLE, LA 71446-5304
(337) 392-1000
(337) 392-1099
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12272R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1697664
—
LA
01
—
5CX36
MEDICARE ID
LA
01
—
C4958
BCBS PROVIDER NUMBER
LA
Enumeration date
04/11/2007
Last updated
09/14/2011
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