Provider Demographics
NPI:1457580805
Name:SOUTHWEST ARLINGTON MEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST ARLINGTON MEDICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-261-3302
Mailing Address - Street 1:2313 W ARKANSAS LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6034
Mailing Address - Country:US
Mailing Address - Phone:817-261-3302
Mailing Address - Fax:817-277-0674
Practice Address - Street 1:2313 W ARKANSAS LN STE 100
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-6034
Practice Address - Country:US
Practice Address - Phone:817-261-3302
Practice Address - Fax:817-277-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097LXOtherBLUE CROSS BLUE SHIELD
TX0097LXOtherBLUE CROSS BLUE SHIELD