Healthcare Provider Details

I. General information

NPI: 1205144029
Provider Name (Legal Business Name): ART MEDICAL ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W ANDERSON LN STE 103
AUSTIN TX
78757-1501
US

IV. Provider business mailing address

PO BOX 203968
AUSTIN TX
78720-3968
US

V. Phone/Fax

Practice location:
  • Phone: 512-467-1100
  • Fax: 512-467-1101
Mailing address:
  • Phone: 512-467-1100
  • Fax: 512-467-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MICHAEL LEE SEGURA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 512-467-1100