Healthcare Provider Details

I. General information

NPI: 1356903827
Provider Name (Legal Business Name): MAIN STREET CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEST 4TH ST
WINONA MN
55987
US

IV. Provider business mailing address

855 MANKATO AVE
WINONA MN
55987-4868
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-3650
  • Fax:
Mailing address:
  • Phone: 507-454-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RACHELLE HEISING SCHULTZ
Title or Position: PRESIDENT/CEO
Credential: ED.D
Phone: 507-454-3650