MEDICARE: BEBD TELEHEALTH

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1730731688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEBD TELEHEALTH

Provider Business Mailing Address
First Line	:	2009 TREMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3959
Country	:	US
Telephone Number	:	817-437-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 TREMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3959
Country	:	US
Telephone Number	:	817-437-3077
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN BRADDOCK
Credential	:
Telephone Number	:	817-437-3077

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	12/20/2019

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Directions to “BEBD TELEHEALTH ” Practice Location

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