| Organization Name: | MAIN STREET MEDICAL CLINIC LLC |
| NPI Number: | 1306145289 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY SUE SUGGS (OWNER) |
| Mailing Address: | 1508 Cogswell Ave Pell City |
| State: | AL US |
| Postal Code: | 351251243 |
| Phone Number: | 2058141598 |
| Fax Number: | 2058141587 |
| NPI Enumeration Date: | 03/18/2011 |
| NPI Last Update Date: | 03/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 113466 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |