Provider Demographics
NPI:1124338785
Name:MACLIN FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:MACLIN FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:877-288-7968
Mailing Address - Street 1:6800 MANHATTAN BLVD BLDG 1
Mailing Address - Street 2:STE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1200
Mailing Address - Country:US
Mailing Address - Phone:817-457-7200
Mailing Address - Fax:817-457-7258
Practice Address - Street 1:1521 N COOPER ST STE 213
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5522
Practice Address - Country:US
Practice Address - Phone:877-288-7968
Practice Address - Fax:754-218-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316936941Medicaid