MEDICARE: MEDCARE CLINC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	L5229	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0063RH	OTHER	TX	BLUE CROSS GROUP
2	8BG010	OTHER	TX	BLUE CROSS NUMBER

General Provider Information

NPI Number	:	1386807659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCARE CLINC

Provider Business Mailing Address
First Line	:	12834 WILLOW CTR STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3047
Country	:	US
Telephone Number	:	281-893-3656
Fax Number	:	281-896-3464

Provider Business Practice Location Address
First Line	:	12834 WILLOW CTR STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3047
Country	:	US
Telephone Number	:	281-893-3656
Fax Number	:	281-896-3464

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IFEOMA N ARENE
Credential	:	M.D.
Telephone Number	:	281-893-3656

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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Directions to “MEDCARE CLINC ” Practice Location

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