Provider Demographics
NPI:1245419647
Name:ARLINGTON PREVENTIVE CARE MEDICAL CLINIC P A
Entity Type:Organization
Organization Name:ARLINGTON PREVENTIVE CARE MEDICAL CLINIC P A
Other - Org Name:PREVENTIVE CARE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-419-2973
Mailing Address - Street 1:1800 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6105
Mailing Address - Country:US
Mailing Address - Phone:817-274-0329
Mailing Address - Fax:817-274-0127
Practice Address - Street 1:1800 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6105
Practice Address - Country:US
Practice Address - Phone:817-274-0329
Practice Address - Fax:817-274-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178548701Medicaid
TXG21860Medicare UPIN
TX00243YMedicare PIN