Provider Demographics
NPI:1407380660
Name:BEL ESC WELLNESS PLLC
Entity Type:Organization
Organization Name:BEL ESC WELLNESS PLLC
Other - Org Name:OUR FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:432-218-9000
Mailing Address - Street 1:2304 W MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5830
Mailing Address - Country:US
Mailing Address - Phone:432-218-9000
Mailing Address - Fax:800-708-5070
Practice Address - Street 1:2304 W MICHIGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5830
Practice Address - Country:US
Practice Address - Phone:432-218-9000
Practice Address - Fax:800-708-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty