Provider Demographics
NPI:1558379701
Name:MEDICAL ARTS CLINIC OF NEW BRAUNFELS
Entity Type:Organization
Organization Name:MEDICAL ARTS CLINIC OF NEW BRAUNFELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STIGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-625-6300
Mailing Address - Street 1:264 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7941
Mailing Address - Country:US
Mailing Address - Phone:830-625-6300
Mailing Address - Fax:830-625-6308
Practice Address - Street 1:264 W MILL ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7941
Practice Address - Country:US
Practice Address - Phone:830-625-6300
Practice Address - Fax:830-625-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6747207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00919ROtherMEDICARE ID
TXJ6747OtherLICENSE
TXDD9763OtherMEDICARE RAILROAD
TX8C0650OtherBCBS
TXF99530Medicare UPIN