1447774344 NPI number — BE WELL PRIMARY CARE MEDICINE PLLC

Table of content: (NPI 1447774344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447774344 NPI number — BE WELL PRIMARY CARE MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BE WELL PRIMARY CARE MEDICINE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447774344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 N TARRANT PKWY STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76244-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-593-6660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 NORTH TARRANT PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-593-6660
Provider Business Practice Location Address Fax Number:
888-289-2380
Provider Enumeration Date:
08/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VAYANI
Authorized Official First Name:
RADHIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PHYSICIAN
Authorized Official Telephone Number:
682-593-6660

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1528559325 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1396068870 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497019863 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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