Provider Demographics
NPI:1154325850
Name:OMEGA OB-GYN ASSOCIATES OF SOUTH ARLINGTON
Entity Type:Organization
Organization Name:OMEGA OB-GYN ASSOCIATES OF SOUTH ARLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:817-468-3255
Mailing Address - Street 1:505 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2004
Mailing Address - Country:US
Mailing Address - Phone:817-468-3255
Mailing Address - Fax:817-468-7823
Practice Address - Street 1:505 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2004
Practice Address - Country:US
Practice Address - Phone:817-468-3255
Practice Address - Fax:817-468-7823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192556201Medicaid
TX00AP73Medicare PIN