Provider Demographics
NPI:1013391184
Name:MEDICLINK MANAGEMENT GROUP
Entity Type:Organization
Organization Name:MEDICLINK MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-506-4132
Mailing Address - Street 1:325 MIRON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7829
Mailing Address - Country:US
Mailing Address - Phone:817-506-4132
Mailing Address - Fax:
Practice Address - Street 1:415 E SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6279
Practice Address - Country:US
Practice Address - Phone:817-506-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty