| Evershinemed Bedford | |
|
1701 Forest Ridge Dr Bedford TX 76022-7959 | |
| (817) 545-7700 | |
| (817) 545-2298 |
| Full Name | Evershinemed Bedford |
|---|---|
| Speciality | Family Medicine |
| Location | 1701 Forest Ridge Dr, Bedford, Texas |
| Authorized Official Name and Position | Rahim Ruknudin Sewani (MANAGING MEMBER) |
| Authorized Official Contact | 6308537049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evershinemed Bedford 1701 Forest Ridge Dr Bedford TX 76022-7959 Ph: (817) 545-7700 | Evershinemed Bedford 1701 Forest Ridge Dr Bedford TX 76022-7959 Ph: (817) 545-7700 |
| NPI Number | 1982448296 |
|---|---|
| Provider Enumeration Date | 06/21/2024 |
| Last Update Date | 09/09/2024 |
| Certification Date | 09/09/2024 |
| Medicare PECOS PAC ID | 7113468869 |
|---|---|
| Medicare Enrollment ID | O20240920002164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982448296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Carol a King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184914962 PECOS PAC ID: 3870740665 Enrollment ID: I20120830000151 |
| Provider Name | Charles R Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154364008 PECOS PAC ID: 0547537573 Enrollment ID: I20170523002541 |
| Provider Name | Rahim Ruknudin Sewani |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205463767 PECOS PAC ID: 8022559772 Enrollment ID: I20240920002337 |
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