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General NPI Number Information
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NPI Number | 1083501290
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Entity Type | Organization
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Legal Business Name | MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 4117 OLEANDER DR
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City | WILMINGTON
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State | NC
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Zip | 28403-6821
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Country | US
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Telephone | 256-854-9989
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 3RD AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35203-1828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | ANDREW SMITH
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Credential |
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Telephone | 205-545-5085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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