Provider Demographics
NPI:1629469630
Name:RUFE SNOW CLINIC, INC.
Entity Type:Organization
Organization Name:RUFE SNOW CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REDA
Authorized Official - Middle Name:SABER
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:#104
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3360
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:76148-3360
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:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3989261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60895Medicare UPIN