MAIN STREET MEDICAL GROUP LLC


Address: 124 Regency Park Ste 7, O Fallon, IL 62269-1994
Phone: 4809262260

MAIN STREET MEDICAL GROUP LLC (NPI# 1043832769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1043832769
Entity Type Organization
Organization Name MAIN STREET MEDICAL GROUP LLC
Practice Address 124 Regency Park Ste 7
O Fallon
IL 62269-1994
Mailing Address 2250 E Germann Rd Ste 8
Chandler
AZ 85286-1575
Practice Telephone 4809262260
Enumeration Date 2020-05-15
Last Update Date 2020-05-15
Authorized Official Name MINOO RAHIMI (CFO)
Authorized Official Telephone 4809267800
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 111N00000X Chiropractor Chiropractic Providers
N 225100000X Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
Physician Assistants & Advanced Practice Nursing Providers
Y 208D00000X General Practice Allopathic & Osteopathic Physicians

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1922499060 Main Street Medical Group LLC Internal Medicine 199 Main St, Suite 200, Keansburg, NJ 07734-1768 2015-02-11

Office Location

Street Address 124 REGENCY PARK STE 7
City O FALLON
State IL
Zip Code 62269-1994

Providers in the same location

NPI Name Taxonomy Address Enumeration
1942712310 Shannon Marie Williams Nurse Practitioner 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2017-10-25
1871115592 Schantz Medical Group LLC Chiropractor 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2020-05-15
1891317517 O Fallon Medical Ventures LLC Chiropractor 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2020-05-15
1063034783 Regency Mark Medical Group LLC Physician Assistant 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2020-05-15
1740788587 New Heights Chiropractic Chiropractor 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2018-01-26
1114431616 New Heights Integrated Health Sc Clinic/Center 124 Regency Park Ste 7, O Fallon, IL 62269-1994 2017-11-21

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1326648155 Kayla Revermann Pharmacist 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 2020-10-30
1942814272 Ashley Monique Gibson Behavior Technician Eagle Center, Ste 10, Ofallon, IL 62269 2020-09-03
1013533819 Michelle Denise Voudrie Registered Nurse 321 Regency Park, O'fallon, IL 62269 2020-06-18
1598398455 Washington University Physicians In Illinois - Cancer Center Pharmacy Pharmacy 1418 Cross Street, Suite 180, Shiloh, IL 62269 2020-02-19
1962063800 Gerald Paskert Pharmacist 122 W. State St., O'fallon, IL 62269 2019-06-21
1780144808 Bonnie Jean Lampe Physical Therapy Assistant 316 Donna Dr, O'fallon, IL 62269 2019-03-24
1134633993 Latisha Smith Psychologist 600 S. Smiley St., O'fallon, IL 62269 2017-11-30
1619407210 Brenna M Thomas Registered Nurse 1310 Engle Ct, O'fallon, IL 62269 2017-06-15
1881135622 Pc Associates, LLC Family Medicine 800 East Highway 50, O'fallon, IL 62269 2017-03-13
1700230539 Jennifer Farrell Family Medicine 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 2016-04-18
Find all providers in zip 62269

Taxonomy Information

Taxonomy Code 208D00000X
Grouping Allopathic & Osteopathic Physicians
Classification General Practice

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1861481558 John Frank Anzalone General Practice 1055 E Terra Ln, O Fallon, MO 63366-2750 2005-10-17
1811076052 Robert F Ladove General Practice 916 Talon Dr, Suite 102, O Fallon, IL 62269-1848 2006-11-06

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1538775192 Discover Integrated Medical Center, Ltd. General Practice 2207 N Us Highway 12 Ste E, Spring Grove, IL 60081-9706 2020-09-18
1154946903 Wound Pros Illinois General Practice 5250 Old Orchard Rd., Suite 300, Skokie, IL 60077-4462 2020-06-08
1306465786 Brightlife Regenerative Medical Clinic Lombard Sc General Practice 442 E Roosevelt Rd, Lombard, IL 60148-4630 2020-04-15
1851920524 Sahens Mezidor General Practice 228 Ridge Ave Apt G, Evanston, IL 60202-6409 2020-04-05
1447881487 Tyrian Healthcare Solutions, LLC General Practice 2120 W Heading Ave, West Peoria, IL 61604-5138 2020-01-29
1598302077 Enhance Medical LLC General Practice 1193 N Gary Ave, Carol Stream, IL 60188-9423 2019-12-04
1164067054 League Corp. General Practice 515 N State St Fl 8, Chicago, IL 60654-9102 2019-11-14
1679129977 Chronic Care Solutions LLC General Practice 3050 W Columbia Ave, Chicago, IL 60645-4006 2019-08-13
1205393972 Midwest Medical LLC General Practice 2001 Midwest Rd Ste Ll22, Oak Brook, IL 60523-1316 2019-02-28
1306311725 Genesis Integrative Medicine LLC General Practice 1881 S Randall Rd Ste C, Geneva, IL 60134-2532 2018-10-11
Find all providers with the same taxonomy

Competitor

Search similar providers

City O FALLON
Zip Code 62269

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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