Main Street Medical Pc

LBN: Main Street Medical Pc
Main Street Medical Pc is an health care organization with primary practice located at 93 Main St , Hilton Head SC 29926-1648. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Main Street Medical Pc can be contacted via phone (843) 681-3777, or through Johnson, Joel Mandus via phone (843) 681-3777.

Contact Information

Primary practice address
93 Main St Hilton Head SC 29926-1648
Phone: (843) 681-3777
Fax: (843) 681-9996
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Joel Mandus Doctor of Medicine (MD)
Phone: (843) 681-3777

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X 18011 South Carolina

Profile Details

NPI number 1922192194
LBN Legal business name Main Street Medical Pc
DBA Doing business as
Authorized official Johnson, Joel Mandus Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 3rd, 2006
Last updated Jan 15th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922192194 NPPES
South Carolina Other 42D0940826 CLIA NUMBER
South Carolina Other 020038172 CLIA NUMBER

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