Main Street Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-7989 Issued in ID

Legal business name

MAIN STREET MEDICAL LLC

Practice address

6641 Kaniksu St
Suite a
Bonners Ferry, ID 83805-7532

Phone

(208) 265-3655

Fax

(208) 267-3757

NPI assigned

Jan 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Chuck Newhouse, MDNPI 1356374664

Title

Owner

Phone

(208) 265-3655

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chuck Lee Newhouse, MD

  • Family Medicine Physician
  • Bonners Ferry, ID
  • NPI 1356374664
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203638400000",
    "number": "1134274103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1640",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838051640",
            "telephone_number": "208-265-3655",
            "fax_number": "208-267-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6641 KANIKSU ST",
            "address_2": "SUITE A",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-265-3655",
            "fax_number": "208-267-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-02-22",
        "status": "A",
        "authorized_official_last_name": "NEWHOUSE",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-265-3655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-7989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO LICENSE",
            "identifier": "M7989",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan J Layeux, MD
• Carol V Lucero, LCSW
• Janet Marie Lukehart, MSN, FNP-BC
• Elisabeth M Mackey, ARNP
• Nicole Diana Madill-Klupenger, LCPC 6404
• Mark R. Barker, O.D.P.C.
• Jessica Martin, RN, BSN
• Alyssa Matthews, OTR/L
• Wendolyn E McClintock, R.D., L.D.
• Jeffrey McDowell, LCPC

• Family Medicine Physician in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.