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NPI Code Detail

MEDICARE: MAIN STREET MEDICAL CLINIC LLC

MEDICARE: MAIN STREET MEDICAL CLINIC LLC
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
1261QR1300XRural Health Clinic/Center113466AL

General Provider Information

NPI Number : 1306145289
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAIN STREET MEDICAL CLINIC LLC
Provider Business Mailing Address
First Line : 1508 COGSWELL AVE
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1243
Country : US
Telephone Number : 205-814-1598
Fax Number : 205-814-1587
Provider Business Practice Location Address
First Line : 1508 COGSWELL AVE
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1243
Country : US
Telephone Number : 205-814-1598
Fax Number : 205-814-1587
Authorized Official
Title or Position : OWNER
Name : MARY SUE SUGGS
Credential : CRNP
Telephone Number : 205-814-1598
Provider Enumeration Date : 03/18/2011
Last Update Date : 03/18/2011

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1205854544 — LINDA J SCHULTZ MD
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Practice Fax:
1003242678 — MS. LAURA PAIGE FARRIS CRNP
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1740895291 — MAIN STREET CLINIC, LLC
Practice Location Address:
1508 COGSWELL AVE
PELL CITY, AL
35125-1243
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Practice Fax: 888-827-8932

Directions to “MAIN STREET MEDICAL CLINIC LLC ” Practice Location

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