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General NPI Number Information
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NPI Number | 1881069995
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Entity Type | Organization
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Legal Business Name | BRIARWOOD CLINIC, LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 5000 BRIARWOOD AVE SUITE 203
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City | MIDLAND
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State | TX
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Zip | 79707-2753
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Country | US
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Telephone | 432-687-6870
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Fax | 432-687-5558
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Provider Business Mailing Address
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Address Line | 2410 N FOWLER ST
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City | HOBBS
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State | NM
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Zip | 88240-2312
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Country | US
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Telephone | 575-392-2040
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Fax | 575-392-6752
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Authorized Official
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Title or Position | ADMINISTRATOR/PRESIDENT
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Name | ALLEN V HURT
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Credential | MD
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Telephone | 575-392-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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