MEDICARE: SOUTH MAIN CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1295619831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MAIN CLINIC INC

Provider Business Mailing Address
First Line	:	12333 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-6205
Country	:	US
Telephone Number	:	713-729-7600
Fax Number	:	713-729-7603

Provider Business Practice Location Address
First Line	:	12333 MAIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-6205
Country	:	US
Telephone Number	:	713-729-7600
Fax Number	:	713-729-7603

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE NICHOLE BROWN
Credential	:
Telephone Number	:	281-753-5509

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	05/19/2026

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Directions to “SOUTH MAIN CLINIC INC ” Practice Location

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