Provider Demographics
NPI:1033118724
Name:JOHN B ARKUSINSKI DO PA
Entity Type:Organization
Organization Name:JOHN B ARKUSINSKI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRUNO
Authorized Official - Last Name:ARKUSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-483-7979
Mailing Address - Street 1:204 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ITALY
Mailing Address - State:TX
Mailing Address - Zip Code:76651
Mailing Address - Country:US
Mailing Address - Phone:972-483-7979
Mailing Address - Fax:972-483-7922
Practice Address - Street 1:204 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651
Practice Address - Country:US
Practice Address - Phone:972-483-7979
Practice Address - Fax:972-483-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152024901Medicaid
TX00773TMedicare PIN