Provider Demographics
NPI:1104635754
Name:AMC MEDICAL CLINIC GROUP INC.
Entity type:Organization
Organization Name:AMC MEDICAL CLINIC GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANJU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-851-2458
Mailing Address - Street 1:4543 ROYAL BEND LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 CABRERA DRIVE, UNIT 902
Practice Address - Street 2:
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:516-851-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care