MEDICARE: MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1184410938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:	205-545-5085
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 LOWES BLVD
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-9005
Country	:	US
Telephone Number	:	828-395-1232
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ANDREW SMITH
Credential	:
Telephone Number	:	205-545-5085

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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