Healthcare Provider Details

I. General information

NPI: 1609063916
Provider Name (Legal Business Name): MAIN STREET MEDCENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MOUNT HERMON RD STE A
SALISBURY MD
21804-5159
US

IV. Provider business mailing address

951 MOUNT HERMON RD STE A
SALISBURY MD
21804-5159
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2700
  • Fax: 410-548-2608
Mailing address:
  • Phone: 410-548-2700
  • Fax: 410-548-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberHOO36690
License Number StateMD

VIII. Authorized Official

Name: MS. JANE ELLEN BURNS
Title or Position: ADMINISTRATOR/OWNER
Credential: CRNP
Phone: 410-548-2700