Provider Demographics
NPI:1770716094
Name:AMERICARE MEDICAL CLINIC
Entity type:Organization
Organization Name:AMERICARE MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:CAMARISTA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:632-567-3914
Mailing Address - Street 1:1350 ROXAS BLVD.
Mailing Address - Street 2:SUITE 710 ERMITA CENTER BLDG.
Mailing Address - City:ERMITA
Mailing Address - State:MANILA
Mailing Address - Zip Code:1000
Mailing Address - Country:PH
Mailing Address - Phone:632-567-3913
Mailing Address - Fax:632-567-3914
Practice Address - Street 1:1350 ROXAS BLVD.
Practice Address - Street 2:SUITE 710 ERMITA CENTER BLDG.
Practice Address - City:ERMITA
Practice Address - State:MANILA
Practice Address - Zip Code:1000
Practice Address - Country:PH
Practice Address - Phone:632-567-3913
Practice Address - Fax:632-567-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QH0100X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service