MEDICARE: MAIN STREET FAMILY PRACTICE PC

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	207Q00000X	Family Medicine Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760489629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIN STREET FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	302 S MAIN STREET
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023
Country	:	US
Telephone Number	:	704-857-8769
Fax Number	:	704-857-8779

Provider Business Practice Location Address
First Line	:	302 S MAIN STREET
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023
Country	:	US
Telephone Number	:	704-857-8769
Fax Number	:	704-857-8779

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ELIZABETH G HILL
Credential	:
Telephone Number	:	704-857-8769

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/21/2022

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Directions to “MAIN STREET FAMILY PRACTICE PC ” Practice Location

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