MAIN STREET MEDICAL PC NPI 1922192194

NPI Information

NPI: 1922192194
Provider Name: MAIN STREET MEDICAL PC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 42D0940826

Address:
93 MAIN ST
HILTON HEAD, SC
ZIP 29926
Phone: (843) 681-3777
Get Directions

MAIN STREET MEDICAL PC is a multi-specialty clinic center in Hilton Head, SC. MAIN STREET MEDICAL PC NPI is 1922192194. The provider is registered as an organization entity type.

The provider's business location address is:

93 MAIN ST
HILTON HEAD, SC
ZIP 29926-648
Phone: (843) 681-3777
Fax: (843) 681-9996

The provider's authorized official is Joel Mandus Johnson .
The authorized official title is Ceo Doctor and has the following contact phone number (843) 681-3777.

The CLIA number assigned to this NPI record is 42D0940826 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/3/2006 and was last updated on 1/15/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	18011	SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	020038172	OTHER	SOUTH CAROLINA	RAIL ROAD MEDICARE
2	42D0940826	OTHER	SOUTH CAROLINA	CLIA NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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