Main Street Family Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAIN STREET FAMILY CLINIC LLC

Practice address

213 W Main St
Canton, OK 73724-1234

Phone

(405) 506-9101

Fax

(405) 936-0561

NPI assigned

May 23, 2025

Organization subpart

No

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

Authorized official

Name

Beth Holderby, APRN

Title

Owner

Phone

(580) 551-9131

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beth R Holderby Acre, NP-C

  • Family Nurse Practitioner
  • Canton, OK
  • NPI 1023433299
  Medicare reassignment NPD

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

{
    "created_epoch": "1747958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1275326191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 57390",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731577390",
            "telephone_number": "405-506-9101",
            "fax_number": "405-936-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 W MAIN ST",
            "city": "CANTON",
            "state": "OK",
            "postal_code": "737241234",
            "telephone_number": "405-506-9101",
            "fax_number": "405-936-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-07-09",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "HOLDERBY",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-551-9131",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirsten Harrelson, DPH
• Herod Drug, LLC
• Herod Drug, LLC.
• Beth R Holderby Acre, NP-C
• Rebecca Carol Johnson
• Melinda Miles
• Sarah Anne Pierce, BSW
• Cynthia Ranae Scott
• Timothy Albert Scott
• Terri Nicole Williams, FNP-C

• Family Medicine Physician in Canton, OK
• Providers in Canton, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.