NPI | 1356582035 |
---|---|
Doing Business As | MAIN STREET MEDICAL |
Entity Type | Organization |
Authorized Contact | SCOTT FEDOSKY Physician 479-571-4325 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: AR E0546) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2717) |
Enumeration Date | 2009-03-10 |
Last Update Date | 2014-04-08 |