Provider Demographics
NPI:1164786869
Name:ARETE PHYSICIANS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ARETE PHYSICIANS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-497-6342
Mailing Address - Street 1:3144 BROADWAY
Mailing Address - Street 2:STE. 4-314
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3838
Mailing Address - Country:US
Mailing Address - Phone:707-497-6342
Mailing Address - Fax:707-497-6234
Practice Address - Street 1:1915 HARRISON AVE
Practice Address - Street 2:STE. A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3230
Practice Address - Country:US
Practice Address - Phone:707-497-6342
Practice Address - Fax:707-497-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057950261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154383875OtherNPI