MAIN STREET MEDICAL CENTER INC (NPI# 1063561041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063561041 |
| Entity Type | Organization |
| Organization Name | MAIN STREET MEDICAL CENTER INC |
| Practice Address |
24 South Main Street Shenandoah PA 17976 |
| Practice Telephone | 5704621033 |
| Practice Fax Number | 5704621171 |
| Mailing Telephone | 5704621033 |
| Mailing Fax Number | 5704621171 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. ADOLPH MICHAEL WYCHULIS (OWNER) |
| Authorized Official Telephone | 5704621033 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD418365 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0019487500001 | 05 |
| Street Address |
24 SOUTH MAIN STREET |
| City | SHENANDOAH |
| State | PA |
| Zip Code | 17976 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518417690 | Eric E. Petterson P.C. | Internal Medicine | 1 S Main St, Shenandoah, PA 17976 | 2016-10-12 |
| 1770875940 | Patricia Ce Domin-shorten | Pharmacist | 42 Main Street, Rite Aid Pharmacy, Shenandoah, PA 17976 | 2011-05-06 |
| 1962603605 | Alexine M Rajnic | Speech-Language Pathologist | 101 E Washington St, Shenandoah Manor Nursing Home, Shenandoah, PA 17976 | 2007-05-30 |
| 1003296997 | Sherley Vasquez | Physical Therapist | 201 Swatara Rd, Shenandoah, PA 17976-1232 | 2015-06-04 |
| 1730139460 | Trinity Mission of Shenandoah Heights, LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2006-05-11 |
| 1902404569 | Shenandoah Heights Healthcare LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2020-10-15 |
| 1215579925 | Morgan Rae Aulenbach | Physical Therapist | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2019-10-14 |
| 1033665930 | Logan J. Zeitler | Occupational Therapist | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2016-08-30 |
| 1124484241 | Ridgeview Operations LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2016-01-05 |
| 1831582485 | Jennifer Hoats | Speech-Language Pathologist | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2015-03-06 |
| Find all providers in zip 17976 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639527732 | Sehar Khateeb | Internal Medicine | 9250 Pinecroft Dr Ste N2.101, Shenandoah, TX 77380-3218 | 2016-05-31 |
| 1053687970 | Holly Bentz Smith | Internal Medicine | 17183 I H 45 S Ste 530, Shenandoah, TX 77385 | 2012-03-25 |
| 1629367602 | Patrick Toluwatele Ogidan | Internal Medicine | 9201 Pinecroft Dr Fl 2, Shenandoah, TX 77380-3889 | 2011-03-30 |
| 1992930929 | Madhavi Machineni | Internal Medicine | 150 Pine Forest Dr Ste 602, Shenandoah, TX 77384 | 2009-05-20 |
| 1518135821 | Rajesh Venkataraman | Internal Medicine | 17183 I H 45 S Ste 650, Shenandoah, TX 77385-3316 | 2008-02-20 |
| 1063621175 | Shivani M Toma | Internal Medicine | 17183 I 45 S Ste 570, Shenandoah, TX 77385-3312 | 2007-05-22 |
| 1245269547 | Eric Evan Petterson | Internal Medicine | 4 W Washington St, Shenandoah, PA 17976-1707 | 2006-07-01 |
| 1528043676 | Frederick I Njuki | Internal Medicine | 286 Ed English Dr Ste B, Shenandoah, TX 77385-8034 | 2005-12-13 |
| 1043201015 | Paula D. Ryan | Internal Medicine | 9200 Pinecroft Dr Ste 450, Shenandoah, TX 77380-3280 | 2005-10-31 |
| 1508853037 | Duyen My Tran | Internal Medicine | 129 Vision Park Blvd, Ste 200, Shenandoah, TX 77384-3024 | 2005-09-30 |
| Find all providers in SHENANDOAH | ||||
| City | SHENANDOAH |
| Zip Code | 17976 |
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| 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.