| Main Street Family Practice, Inc | |
|
533 Main St Logan WV 25601-3809 | |
| (304) 752-3400 | |
| (304) 752-8138 |
| Full Name | Main Street Family Practice, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 533 Main St, Logan, West Virginia |
| Authorized Official Name and Position | Kenneth Sells (PRESIDENT) |
| Authorized Official Contact | 3047523400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Practice, Inc 533 Main St Logan WV 25601-3809 Ph: (304) 752-3400 | Main Street Family Practice, Inc 533 Main St Logan WV 25601-3809 Ph: (304) 752-3400 |
| NPI Number | 1073542809 |
|---|---|
| Provider Enumeration Date | 07/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073542809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 016632 (West Virginia) | Primary |
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