H Pena MD North Main Medical and Surgical Clinic Assoc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C7083 Issued in TX

Legal business name

H PENA MD NORTH MAIN MEDICAL AND SURGICAL CLINIC ASSOC

Practice address

3301 North Main Street
Fort Worth, TX 76106

Phone

(817) 625-2791

Fax

(817) 740-1550

NPI assigned

Jan 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Heriberto Pena, MD

Title

President

Phone

(817) 625-2791

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477607240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 NORTH MAIN STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76106",
            "telephone_number": "817-625-2791",
            "fax_number": "817-740-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 NORTH MAIN STREET",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76106",
            "telephone_number": "817-625-2791",
            "fax_number": "817-740-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H PENA MD NORTH MAIN MEDICAL AND SURGICAL CLINIC ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "HERIBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-625-2791",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": "C7083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Fort Worth, TX
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• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.