Provider Demographics
NPI:1255509097
Name:RUFE SNOW CLINIC INC
Entity Type:Organization
Organization Name:RUFE SNOW CLINIC INC
Other - Org Name:RUFE SNOW CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BESTAWROUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-498-6944
Mailing Address - Street 1:6651 WATAUGA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148
Mailing Address - Country:US
Mailing Address - Phone:817-498-6944
Mailing Address - Fax:817-581-3920
Practice Address - Street 1:6651 WATAUGA RD
Practice Address - Street 2:104
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148
Practice Address - Country:US
Practice Address - Phone:817-498-6944
Practice Address - Fax:817-581-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89540XOtherBCBS
TX0A0057Medicare PIN
G60895Medicare UPIN