Main St. Medical Center of Vidor

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MDE9547 Issued in TX

Legal business name

MAIN ST. MEDICAL CENTER OF VIDOR

Practice address

1091 N Main St
Ste B
Vidor, TX 77662-4339

Phone

(409) 769-0237

Fax

(409) 769-0254

NPI assigned

Jul 18, 2007

Organization subpart

No

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

Authorized official

Name

Duncan G Bowell, M.D.

Title

Doctor

Phone

(409) 769-0237

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

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

• Samantha Joleen Bioseh, APRN, FNP-C

  • Family Nurse Practitioner
  • Huntsville, TX
  • NPI 1861962136
  NPD (past)

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1205036233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1091 N MAIN ST",
            "address_2": "STE B",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776624339",
            "telephone_number": "409-769-0237",
            "fax_number": "409-769-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 N MAIN ST",
            "address_2": "STE B",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776624339",
            "telephone_number": "409-769-0237",
            "fax_number": "409-769-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN ST. MEDICAL CENTER OF VIDOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-18",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "BOWELL",
        "authorized_official_first_name": "DUNCAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "409-769-0237",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "MDE9547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00298682",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0017MH",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Nicole Lewallen, M.S. CCC-SLP
• Liberty County Hospital District No. 1
• Taryn Danee Light, SPEECH-LANGUAGE PATH
• Barbara Chyenne Loftin
• Austin Mackey
• Shelly Maines, PT
• Merilyn Howton Marriott, M.S., LPC
• Merilyn Howton Marriott
• Michael K Crossley, M D P a
• Minor Home Healthcare & Housekeeping Associates

• Family Medicine Physician in Vidor, TX
• Providers in Vidor, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.