South Main Medical | |
620 S Main St Santa Ana CA 92701-5716 | |
(714) 547-6485 | |
(714) 285-9466 |
Full Name | South Main Medical |
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Speciality | Family Medicine |
Location | 620 S Main St, Santa Ana, California |
Authorized Official Name and Position | Carmen Bucci (CORPORATION SECRETARY/TREASURER) |
Authorized Official Contact | 7145476485 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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South Main Medical 620 S Main St Santa Ana CA 92701-5716 Ph: (714) 547-6485 | South Main Medical 620 S Main St Santa Ana CA 92701-5716 Ph: (714) 547-6485 |
NPI Number | 1982839809 |
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Provider Enumeration Date | 05/21/2009 |
Last Update Date | 06/09/2010 |
Medicare PECOS PAC ID | 8224166913 |
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Medicare Enrollment ID | O20100518000272 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982839809 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | A63690 (California) | Primary |
Provider Name | Bruno Bucci |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407811250 PECOS PAC ID: 9032247721 Enrollment ID: I20100518000288 |
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