Provider Demographics
NPI:1467568865
Name:MEDICAL ARTS CLINIC PROFESSIONAL ASSOCIATION OF ARANSAS PASS
Entity Type:Organization
Organization Name:MEDICAL ARTS CLINIC PROFESSIONAL ASSOCIATION OF ARANSAS PASS
Other - Org Name:MEDICAL ARTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-758-5326
Mailing Address - Street 1:1731 W WHEELER
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336
Mailing Address - Country:US
Mailing Address - Phone:361-758-5326
Mailing Address - Fax:361-758-2137
Practice Address - Street 1:1731 W WHEELER
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336
Practice Address - Country:US
Practice Address - Phone:361-758-5326
Practice Address - Fax:361-758-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N894OtherBLUE SHIELD
TX00N894Medicare PIN
TXCP2136Medicare PIN