Healthcare Provider Details

I. General information

NPI: 1386807659
Provider Name (Legal Business Name): MEDCARE CLINC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12834 WILLOW CTR STE E
HOUSTON TX
77066-3047
US

IV. Provider business mailing address

12834 WILLOW CTR STE E
HOUSTON TX
77066-3047
US

V. Phone/Fax

Practice location:
  • Phone: 281-893-3656
  • Fax: 281-896-3464
Mailing address:
  • Phone: 281-893-3656
  • Fax: 281-896-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberL5229
License Number StateTX

VIII. Authorized Official

Name: DR. IFEOMA N ARENE
Title or Position: OWNER
Credential: M.D.
Phone: 281-893-3656