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General NPI Number Information
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NPI Number | 1457176695
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Entity Type | Organization
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Legal Business Name | MAIN STREET PRIMARY CARE & AESTHETICS, PLLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 2003 OLD MAIN ST
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City | MAYSVILLE
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State | KY
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Zip | 41056-8928
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Country | US
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Telephone | 606-759-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 870 WOODLAND DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9604
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Country | US
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Telephone | 606-584-5658
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Fax |
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Authorized Official
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Title or Position | APRN/OWNER
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Name | TINA GIFFORD
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Credential |
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Telephone | 606-758-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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