MEDICARE: BEDFORD SURGERY CENTER LLC

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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1164381331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDFORD SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1600 CENTRAL DR STE 180
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6029
Country	:	US
Telephone Number	:	817-705-6517
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CENTRAL DR STE 180
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6029
Country	:	US
Telephone Number	:	817-705-6517
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	CARAH GODINEZ
Credential	:
Telephone Number	:	817-705-6517

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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