| South Main Clinic, Inc | |
|
12333 Main St Houston TX 77035-6205 | |
| (713) 729-7600 | |
| (713) 729-7603 |
| Full Name | South Main Clinic, Inc |
|---|---|
| Speciality | Legal Medicine |
| Location | 12333 Main St, Houston, Texas |
| Authorized Official Name and Position | Alvaro Pinilla (PRESIDENT OWNER) |
| Authorized Official Contact | 7137297600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Main Clinic, Inc 12333 Main St Houston TX 77035-6205 Ph: (713) 729-7600 | South Main Clinic, Inc 12333 Main St Houston TX 77035-6205 Ph: (713) 729-7600 |
| NPI Number | 1326068933 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 3678525581 |
|---|---|
| Medicare Enrollment ID | O20050218000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326068933 | NPI | - | NPPES |
| 1427078674 | Other | TX | DR. MONTGOMERY NPI |
| 0087MG | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 173000000X | Legal Medicine | (* (Not Available)) | Primary |
| Provider Name | Rodolfo Mendez Cancel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649491648 PECOS PAC ID: 7719978956 Enrollment ID: I20040518001256 |
| Provider Name | Ryan T Thai |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568463891 PECOS PAC ID: 0840244067 Enrollment ID: I20051207000261 |
| Provider Name | Danielle N Brown |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306194329 PECOS PAC ID: 4789803552 Enrollment ID: I20140910001714 |
| Provider Name | Miguel A Nieto |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003263468 PECOS PAC ID: 1254682727 Enrollment ID: I20180921001508 |
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