Basic Information
| Provider Information | |||||||||
| NPI: | 1528510260 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEL ESC HEALTH, PLLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | OUR FAMILY URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2304 W MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326956932 | ||||||||
| FaxNumber: | 8007085070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2304 W MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326956932 | ||||||||
| FaxNumber: | 8007085070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 03/14/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | DOROTHY | ||||||||
| AuthorizedOfficialMiddleName: | PAULINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7138934773 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.