Organization
KELL WEST FAMILY PRACTICE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEAL ALLAN MOISANT D.O. (GENERAL PARTNER)
(940) 696-0011
Entity
Organization
Contact information
Practice address
5500 KELL WEST BLVD, SUITE 400, WICHITA FALLS, TX 76310-1612
(940) 696-0011
(940) 696-2248
Mailing address
5500 KELL BLVD, SUITE 400, WICHITA FALLS, TX 76310-1612
(940) 696-0011
(940) 696-2248
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078HQ
BCBS OF TEXAS
TX
01
—
CK5579
RAILROAD MEDICARE
TX
Enumeration date
05/16/2006
Last updated
08/22/2020
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