Healthcare Provider Details

I. General information

NPI: 1881069995
Provider Name (Legal Business Name): BRIARWOOD CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BRIARWOOD AVE SUITE 203
MIDLAND TX
79707-2753
US

IV. Provider business mailing address

2410 N FOWLER ST
HOBBS NM
88240-2312
US

V. Phone/Fax

Practice location:
  • Phone: 432-687-6870
  • Fax: 432-687-5558
Mailing address:
  • Phone: 575-392-2040
  • Fax: 575-392-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALLEN V HURT
Title or Position: ADMINISTRATOR/PRESIDENT
Credential: MD
Phone: 575-392-2040