MAIN STREET MEDICAL LLC NPI 1487079505

NPI Information

NPI: 1487079505
Provider Name: MAIN STREET MEDICAL LLC

Doing Business As: MAIN STREET MEDICAL CENTERS

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
10549 N FLORIDA AVE STE A/I
TAMPA, FL
ZIP 33612
Phone: (813) 220-1400
Get Directions

MAIN STREET MEDICAL LLC is a primary care clinic center in Tampa, FL. MAIN STREET MEDICAL LLC NPI is 1487079505. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Main Street Medical Centers.

The provider's business location address is:

10549 N FLORIDA AVE STE A/I
TAMPA, FL
ZIP 33612-707
Phone: (813) 220-1400
Fax: (813) 440-6484

The provider's authorized official is Stephen O Banjoko .
The authorized official title is Cfo and has the following contact phone number (212) 257-0225.

The CLIA number assigned to this NPI record is 10D2182880 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2014 and was last updated on 2/7/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207QA0505X	Family Medicine	Adult Medicine	No
2	2084A0401X	Psychiatry & Neurology	Addiction Medicine	No
3	2084P0800X	Psychiatry & Neurology	Psychiatry	No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	No
5	261QP2300X	Clinic/Center	Primary Care	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	LK078	OTHER	FLORIDA	MEDICARE
2	104624600	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »