Healthcare Provider Details

I. General information

NPI: 1942584537
Provider Name (Legal Business Name): BEWELL & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E LAKE DR
GLADEWATER TX
75647-9205
US

IV. Provider business mailing address

1408 E LAKE DR
GLADEWATER TX
75647-9205
US

V. Phone/Fax

Practice location:
  • Phone: 903-399-0858
  • Fax: 877-879-7379
Mailing address:
  • Phone: 903-399-0858
  • Fax: 877-879-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number11039
License Number StateTX

VIII. Authorized Official

Name: BEVERLY SKINNER-WELLS
Title or Position: GENERAL MANAGER
Credential: ARMDS/RVT
Phone: 903-399-0858