Provider Demographics
NPI:1760540348
Name:BEL-AMI DERMATOLOGY
Entity Type:Organization
Organization Name:BEL-AMI DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-944-3376
Mailing Address - Street 1:3123 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6977
Mailing Address - Country:US
Mailing Address - Phone:325-944-3376
Mailing Address - Fax:325-944-3306
Practice Address - Street 1:3123 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6977
Practice Address - Country:US
Practice Address - Phone:325-944-3376
Practice Address - Fax:325-944-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000080R4Medicaid
TXG69326Medicare UPIN
TX00080RMedicare ID - Type Unspecified