| Southmore Medical Clinic | |
|
629 E Southmore Pasadena TX 77502-1107 | |
| (713) 475-1933 | |
| Not Available |
| Full Name | Southmore Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 629 E Southmore, Pasadena, Texas |
| Authorized Official Name and Position | Vipul M Patel (OWNER) |
| Authorized Official Contact | 7134751933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southmore Medical Clinic 629 E Southmore Ave Pasadena TX 77502 Ph: (713) 475-1933 | Southmore Medical Clinic 629 E Southmore Pasadena TX 77502-1107 Ph: (713) 475-1933 |
| NPI Number | 1760666002 |
|---|---|
| Provider Enumeration Date | 12/21/2007 |
| Last Update Date | 01/02/2008 |
| Medicare PECOS PAC ID | 5294899498 |
|---|---|
| Medicare Enrollment ID | O20090203000552 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760666002 | NPI | - | NPPES |
| 0027HQ | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Vipul M Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700994613 PECOS PAC ID: 7214091412 Enrollment ID: I20090203000541 |
| Provider Name | Blessy S Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831499029 PECOS PAC ID: 7416105176 Enrollment ID: I20120921000346 |
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