Healthcare Provider Details

I. General information

NPI: 1164786869
Provider Name (Legal Business Name): ARETE PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HARRISON AVE STE. A
EUREKA CA
95501-3230
US

IV. Provider business mailing address

3144 BROADWAY STE. 4-314
EUREKA CA
95501-3838
US

V. Phone/Fax

Practice location:
  • Phone: 707-497-6342
  • Fax: 707-497-6234
Mailing address:
  • Phone: 707-497-6342
  • Fax: 707-497-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG057950
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL CALVIN WINDHAM
Title or Position: CEO
Credential: M.D.
Phone: 707-497-6342