| Ellis G Main Do Pa | |
|
3022 Mckinzie Rd Corpus Christi TX 78410-2628 | |
| (361) 241-6700 | |
| Not Available |
| Full Name | Ellis G Main Do Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 3022 Mckinzie Rd, Corpus Christi, Texas |
| Authorized Official Name and Position | Ellis Gerard Main (OWNER) |
| Authorized Official Contact | 3612416700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis G Main Do Pa Po Box 10426 Corpus Christi TX 78460-0426 Ph: (361) 241-6700 | Ellis G Main Do Pa 3022 Mckinzie Rd Corpus Christi TX 78410-2628 Ph: (361) 241-6700 |
| NPI Number | 1851586853 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 08/15/2022 |
| Medicare PECOS PAC ID | 3274657309 |
|---|---|
| Medicare Enrollment ID | O20100826000583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851586853 | NPI | - | NPPES |
| 149471801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J2176 (Texas) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Linda M Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295752814 PECOS PAC ID: 8628065364 Enrollment ID: I20040426001911 |
| Provider Name | Ellis Gerard Main |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366440919 PECOS PAC ID: 1658281639 Enrollment ID: I20051122000309 |
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