| Organization Name: | OFF MAIN STREET MEDICAL |
| NPI Number: | 1023408614 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHARON LYNN SCRUGGS (OWNER) |
| Mailing Address: | 336 Eureka Street Taylorsville |
| State: | MS US |
| Postal Code: | 391680291 |
| Phone Number: | 6017854322 |
| Fax Number: | 6017856681 |
| NPI Enumeration Date: | 02/03/2015 |
| NPI Last Update Date: | 02/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R764114 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |