| 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 |