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General NPI Number Information
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NPI Number | 1205036738
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Entity Type | Organization
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Legal Business Name | MAIN STREET MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 619 MAIN ST W
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City | RIPLEY
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State | WV
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Zip | 25271-1107
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Country | US
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Telephone | 304-372-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 619 MAIN ST W
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City | RIPLEY
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State | WV
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Zip | 25271-1107
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Country | US
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Telephone | 304-372-8088
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Fax | 304-372-8609
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBIE ONEIL
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Credential |
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Telephone | 304-372-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2013
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2013
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License Number State | WV
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