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NPI Code Detail

MEDICARE: EDEN REJUVENATION CENTER FOR WELLBEING PLLC

MEDICARE: EDEN REJUVENATION CENTER FOR WELLBEING PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11700170867OTHERTXNPI

General Provider Information

NPI Number : 1023602588
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDEN REJUVENATION CENTER FOR WELLBEING PLLC
Provider Business Mailing Address
First Line : 5605 FM 423, STE 500- 355
Second Line :
City : FRISCO
State : TX
Zip : 75036-8960
Country : US
Telephone Number : 817-731-6121
Fax Number :
Provider Business Practice Location Address
First Line : 6913 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7163
Country : US
Telephone Number : 267-471-7431
Fax Number : 817-732-8015
Authorized Official
Title or Position : MD
Name : BIJU MATHEW
Credential :
Telephone Number : 267-471-7431
Provider Enumeration Date : 02/25/2021
Last Update Date : 11/19/2025

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