Main Street Medical Centers | |
6506 Embassy Blvd Port Richey FL 34668-4734 | |
(727) 378-2987 | |
Not Available |
Full Name | Main Street Medical Centers |
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Speciality | Clinic/Center |
Location | 6506 Embassy Blvd, Port Richey, Florida |
Authorized Official Name and Position | Stephen O Banjoko (CFO) |
Authorized Official Contact | 2122570225 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Main Street Medical Centers Po Box 17175 Tampa FL 33682-7175 Ph: (813) 220-1400 | Main Street Medical Centers 6506 Embassy Blvd Port Richey FL 34668-4734 Ph: (727) 378-2987 |
NPI Number | 1457826398 |
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Provider Enumeration Date | 10/08/2018 |
Last Update Date | 08/09/2024 |
Medicare PECOS PAC ID | 6204173495 |
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Medicare Enrollment ID | O20190125001442 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457826398 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Okoroafor N Maduagwu |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1588058325 PECOS PAC ID: 4981914736 Enrollment ID: I20151105002215 |
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