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General NPI Number Information
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NPI Number | 1629295621
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Entity Type | Organization
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Legal Business Name | KELL PRIMARY CARE PA
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 5500 KELL WEST BLVD SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76310
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Country | US
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Telephone | 940-692-6200
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Fax | 940-692-6206
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Provider Business Mailing Address
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Address Line | 5500 KELL WEST BLVD SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76310
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Country | US
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Telephone | 940-692-6200
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Fax | 940-692-6206
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Authorized Official
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Title or Position | OWNERMEMBER
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Name | BRIAN C HULL
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Credential | D.O.
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Telephone | 940-692-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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