MEDICARE: ARCLIGHT MBC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TE1100X	Exercise & Sports Psychologist
2	1041C0700X	Clinical Social Worker
3	133V00000X	Registered Dietitian
4	207R00000X	Internal Medicine Physician
5	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician
6	2084N0600X	Clinical Neurophysiology Physician
7	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician
8	208M00000X	Hospitalist Physician
9	213E00000X	Podiatrist
10	261QU0200X	Urgent Care Clinic/Center
11	363LF0000X	Family Nurse Practitioner
12	363LG0600X	Gerontology Nurse Practitioner
13	364SF0001X	Family Health Clinical Nurse Specialist
14	364SG0600X	Gerontology Clinical Nurse Specialist
15	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558998336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCLIGHT MBC LLC

Provider Business Mailing Address
First Line	:	1535 BRADY BLVD
Second Line	:	STE #2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4355
Country	:	US
Telephone Number	:	210-598-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 BRADY BLVD
Second Line	:	STE #2
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4355
Country	:	US
Telephone Number	:	210-598-6868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PETE KOSKO
Credential	:
Telephone Number	:	210-416-1314

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	04/15/2020

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Directions to “ARCLIGHT MBC LLC ” Practice Location

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