| Main Street Medical Pllc | |
|
650 Main St Barboursville WV 25504-1439 | |
| (304) 733-6484 | |
| (304) 733-6486 |
| Full Name | Main Street Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 650 Main St, Barboursville, West Virginia |
| Authorized Official Name and Position | Robert B Walker (PRESIDENT) |
| Authorized Official Contact | 3047336484 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Medical Pllc 650 Main St Barboursville WV 25504-1439 Ph: (304) 733-6484 | Main Street Medical Pllc 650 Main St Barboursville WV 25504-1439 Ph: (304) 733-6484 |
| NPI Number | 1801125752 |
|---|---|
| Provider Enumeration Date | 12/23/2009 |
| Last Update Date | 12/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801125752 | NPI | - | NPPES |
| 0056287000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 10652 (West Virginia) | Primary |
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