Provider Demographics
NPI:1326068933
Name:SOUTH MAIN CLINIC, INC
Entity Type:Organization
Organization Name:SOUTH MAIN CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:PINILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-729-7600
Mailing Address - Street 1:12333 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6205
Mailing Address - Country:US
Mailing Address - Phone:713-729-7600
Mailing Address - Fax:713-729-7603
Practice Address - Street 1:12333 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6205
Practice Address - Country:US
Practice Address - Phone:713-729-7600
Practice Address - Fax:713-729-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427078674OtherDR. MONTGOMERY NPI
TX0087MGOtherBCBS
TX0087MGOtherBCBS
TX00288YMedicare ID - Type UnspecifiedGROUP