MEDICARE: MAINSTREET AND KIDSSTREET OF SOUTH CAROLINA LLC

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	:	1790517225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSTREET AND KIDSSTREET OF SOUTH CAROLINA LLC

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E COLUMBIA AVE UNIT B
Second Line	:
City	:	BATESBURG LEESVILLE
State	:	SC
Zip	:	29006-2130
Country	:	US
Telephone Number	:	205-545-5085
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DREW SMITH
Credential	:
Telephone Number	:	205-545-5085

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	03/04/2025

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