| Main Street Physicians | |
|
157 North Main Street Suite A Suffolk VA 23434 | |
| (757) 925-1866 | |
| (757) 928-0906 |
| Full Name | Main Street Physicians |
|---|---|
| Speciality | Clinic/Center |
| Location | 157 North Main Street Suite A, Suffolk, Virginia |
| Authorized Official Name and Position | Angela Futrell (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7579251866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Physicians 1033 28th St 2nd Floor Newport News VA 23607-4233 Ph: (757) 591-0643 | Main Street Physicians 157 North Main Street Suite A Suffolk VA 23434 Ph: (757) 925-1866 |
| NPI Number | 1538292123 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 11/01/2012 |
| Medicare PECOS PAC ID | 9234040148 |
|---|---|
| Medicare Enrollment ID | O20101014000684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538292123 | NPI | - | NPPES |
| 7687648 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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