Organization Name: | RUFE SNOW CLINIC, INC. |
NPI Number: | 1629469630 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REDA SABER BESTAWROUS (OWNER) |
Mailing Address: | 6651 Watauga Rd #104 Watauga |
State: | TX US |
Postal Code: | 761483360 |
Phone Number: | 8174986944 |
Fax Number: | 8175813920 |
NPI Enumeration Date: | 02/12/2015 |
NPI Last Update Date: | 02/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | K3989 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |