Provider Demographics
NPI:1790383222
Name:SAFELY, CHARLES
Entity Type:Organization
Organization Name:SAFELY, CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SAFELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-284-1496
Mailing Address - Street 1:1252 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4244
Mailing Address - Country:US
Mailing Address - Phone:817-360-3778
Mailing Address - Fax:817-284-3923
Practice Address - Street 1:1252 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4244
Practice Address - Country:US
Practice Address - Phone:817-360-3778
Practice Address - Fax:817-284-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099605003Medicaid