Organization
ART MEDICAL ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LEE SEGURA (PRACTICE MANAGER)
(512) 467-1100
Entity
Organization
Contact information
Practice address
911 W ANDERSON LN, STE 103, AUSTIN, TX 78757-1501
(512) 467-1100
(512) 467-1101
Mailing address
PO BOX 203968, AUSTIN, TX 78720-3968
(512) 467-1100
(512) 467-1101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB126057
MEDICARE PTAN
TX
Enumeration date
09/14/2010
Last updated
09/24/2012
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