MAIN STREET FAMILY MEDICAL LLC NPI 1952025249

NPI Information

NPI: 1952025249
Provider Name: MAIN STREET FAMILY MEDICAL, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 37D2270175

Address:
701 W BROADWAY ST
SPIRO, OK
ZIP 74959
Phone: (918) 962-8009
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MAIN STREET FAMILY MEDICAL, LLC is a primary care clinic center in Spiro, OK. MAIN STREET FAMILY MEDICAL, LLC NPI is 1952025249. The provider is registered as an organization entity type.

The provider's business location address is:

701 W BROADWAY ST
SPIRO, OK
ZIP 74959-456
Phone: (918) 962-8009
Fax: (918) 962-8027

The provider's authorized official is Elizabeth Trudy Davis .
The authorized official title is Founder and has the following contact phone number (918) 448-7854.

The CLIA number assigned to this NPI record is 37D2270175 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/29/2022 and was last updated on 9/7/2023.

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	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

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

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