Provider Demographics
NPI:1114084738
Name:MEDICAL ARTS CENTERS INC
Entity Type:Organization
Organization Name:MEDICAL ARTS CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COCKRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-630-6071
Mailing Address - Street 1:950 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024
Mailing Address - Country:US
Mailing Address - Phone:816-630-6071
Mailing Address - Fax:816-630-4465
Practice Address - Street 1:950 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPGS
Practice Address - State:MO
Practice Address - Zip Code:64024
Practice Address - Country:US
Practice Address - Phone:816-630-6071
Practice Address - Fax:816-630-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD280000Medicare PIN
MOD270000Medicare PIN