MEDICARE: MAIN STREET MEDICAL CLINIC, P.A.

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	208000000X	Pediatrics Physician	MC-2252	AR
2	207R00000X	Internal Medicine Physician	MC-2252	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841298791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIN STREET MEDICAL CLINIC, P.A.

Provider Business Mailing Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3337
Country	:	US
Telephone Number	:	501-315-0059
Fax Number	:	501-315-1320

Provider Business Practice Location Address
First Line	:	722 N MAIN ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3337
Country	:	US
Telephone Number	:	501-315-0059
Fax Number	:	501-315-1320

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHERYL WILCHMAN
Credential	:
Telephone Number	:	501-315-0059

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	05/20/2021

Similar Medicare Providers

1265430201 — CLAY B BRASHEARS M.D.
Practice Location Address:

722 N MAIN ST
BENTON, AR
72015-3337

Practice Phone: 501-315-0059
Practice Fax: 501-315-1320

1720081607 — MICHAEL J. SCHMIDT MD
Practice Location Address:

5 MEDICAL PARK PLACE , STE 308
BENTON, AR
72015-3745

Practice Phone: 501-315-7808
Practice Fax: 501-315-4888

1497753198 — BENTON PEDIATRIC CLINIC
Practice Location Address:

115 MCNEIL ST
BENTON, AR
72015-3345

Practice Phone: 501-315-0421
Practice Fax: 501-778-6312

1285633453 — HOMELINK HOME HEALTH CARE
Practice Location Address:

1102 W SOUTH ST STE 11&12
BENTON, AR
72015-4053

Practice Phone: 501-778-0443
Practice Fax: 501-778-5722

1699774794 — OPHTHALMOLOGY ASSOCIATES OF BENTON, PLLC
Practice Location Address:

3 MEDICAL PARK DR , SUITE 300
BENTON, AR
72015-3728

Practice Phone: 501-778-1113
Practice Fax: 501-778-5391

1457352056 — RANDALL GREEN PT
Practice Location Address:

1115 FERGUSON DR
BENTON, AR
72015-3512

Practice Phone: 501-315-0639
Practice Fax: 501-315-7278

Directions to “MAIN STREET MEDICAL CLINIC, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.