MEDICARE: MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1558075689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC

Provider Business Mailing Address
First Line	:	1500 1ST AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1865
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 OLEANDER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6821
Country	:	US
Telephone Number	:	256-854-9989
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	KRISTA ROCK
Credential	:
Telephone Number	:	205-545-5090

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	03/20/2026

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