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Contact Information

MAIN STREET MEDICAL CENTER INC
24 SOUTH MAIN STREET
SHENANDOAH, PA17976
 Phone: 570-462-1033
 Fax: 570-462-1171
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MAIN STREET MEDICAL CENTER INC

NPI Number 1063561041
LBN Legal business name MAIN STREET MEDICAL CENTER INC
Authorized official ADOLPH WYCHULIS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/09/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
PA License # MD418365
PA Medicaid 0019487500001
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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