Provider Demographics
NPI:1881069995
Name:BRIARWOOD CLINIC, LLC
Entity type:Organization
Organization Name:BRIARWOOD CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-392-2040
Mailing Address - Street 1:2410 N FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2312
Mailing Address - Country:US
Mailing Address - Phone:575-392-2040
Mailing Address - Fax:575-392-6752
Practice Address - Street 1:5000 BRIARWOOD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2753
Practice Address - Country:US
Practice Address - Phone:432-687-6870
Practice Address - Fax:432-687-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358966503Medicaid