Provider Demographics
NPI:1942584537
Name:BEWELL & ASSOCIATES LLC
Entity Type:Organization
Organization Name:BEWELL & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER-WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:ARMDS/RVT
Authorized Official - Phone:903-399-0858
Mailing Address - Street 1:1408 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-9205
Mailing Address - Country:US
Mailing Address - Phone:903-399-0858
Mailing Address - Fax:877-879-7379
Practice Address - Street 1:1408 E LAKE DR
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-9205
Practice Address - Country:US
Practice Address - Phone:903-399-0858
Practice Address - Fax:877-879-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-01
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11039335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11039OtherARMDS-RVT