=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104051234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST BELT MEDICAL, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1160 BLALOCK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-7421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-1272
-----------------------------------------------------
Fax | 713-980-3905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 BLALOCK RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-7421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-1272
-----------------------------------------------------
Fax | 713-980-3905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY TREASURE
-----------------------------------------------------
Name | MRS. LINDA MORROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-468-1272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------