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General NPI Number Information
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NPI Number | 1942584537
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Entity Type | Organization
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Legal Business Name | BEWELL & ASSOCIATES LLC
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Dates
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Enumeration Date | 10/01/2011
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 1408 E LAKE DR
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City | GLADEWATER
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State | TX
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Zip | 75647-9205
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Country | US
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Telephone | 903-399-0858
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Fax | 877-879-7379
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Provider Business Mailing Address
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Address Line | 1408 E LAKE DR
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City | GLADEWATER
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State | TX
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Zip | 75647-9205
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Country | US
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Telephone | 903-399-0858
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Fax | 877-879-7379
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | BEVERLY SKINNER-WELLS
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Credential | ARMDS/RVT
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Telephone | 903-399-0858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 11039
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License Number State | TX
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