Provider Demographics
NPI:1295092567
Name:ARCA MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:ARCA MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-788-6300
Mailing Address - Street 1:1712 N FRAZIER ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1347
Mailing Address - Country:US
Mailing Address - Phone:936-788-6300
Mailing Address - Fax:866-521-8363
Practice Address - Street 1:1712 N FRAZIER ST
Practice Address - Street 2:SUITE 118
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1347
Practice Address - Country:US
Practice Address - Phone:936-788-6300
Practice Address - Fax:866-521-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty