Provider Demographics
NPI:1124201652
Name:SOUTHTOWN CLINIC, PC
Entity Type:Organization
Organization Name:SOUTHTOWN CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GOMEZ
Authorized Official - Last Name:CURLL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:210-228-9340
Mailing Address - Street 1:1025 S PRESA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1359
Mailing Address - Country:US
Mailing Address - Phone:210-228-9340
Mailing Address - Fax:210-228-9342
Practice Address - Street 1:1025 S PRESA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1359
Practice Address - Country:US
Practice Address - Phone:210-228-9340
Practice Address - Fax:210-228-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty