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General NPI Number Information
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NPI Number | 1023408614
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Entity Type | Organization
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Legal Business Name | OFF MAIN STREET MEDICAL PLLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 336 EUREKA STREET
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-0291
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Country | US
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Telephone | 601-785-4322
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Fax | 601-785-6681
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Provider Business Mailing Address
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Address Line | PO BOX 291 336 EUREKA STREET
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-0291
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Country | US
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Telephone | 601-785-4322
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Fax | 601-785-6681
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Authorized Official
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Title or Position | OWNER
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Name | SHARON L SCRUGGS
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Credential | CFNP
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Telephone | 601-785-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R764114
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License Number State | MS
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