Basic Information
| Provider Information | |||||||||
| NPI: | 1407380660 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEL ESC WELLNESS PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OUR FAMILY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2304 W MICHIGAN AVE STE A | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322189000 | ||||||||
| FaxNumber: | 8007085070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2304 W MICHIGAN AVE STE A | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322189000 | ||||||||
| FaxNumber: | 8007085070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2017 | ||||||||
| LastUpdateDate: | 04/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | PAULINE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 4322189000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.