Provider Demographics
NPI:1801205307
Name:AC MEDICAL MANAGEMENT GROUP
Entity type:Organization
Organization Name:AC MEDICAL MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-633-9502
Mailing Address - Street 1:2596 E ARKANSAS LN
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-1764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2596 E ARKANSAS LN
Practice Address - Street 2:SUITE 190
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-1764
Practice Address - Country:US
Practice Address - Phone:817-633-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX373166Medicare UPIN