NPIMap

Organization Active NPI

Main Street Medical Clinic

  • Specialist
  • Thonotosassa, FL
National Provider Identifier
1346570389
Registry record updated Jan 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
ME88205 Issued in FL
Legal business name
MAIN STREET MEDICAL CLINIC
Practice address
10802 E. Main St
Ste B
Thonotosassa, FL 33592-2840
Phone
(813) 413-8258
Fax
(813) 413-8310
NPI assigned
Jan 13, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2010

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

Authorized official

Name
Mrs. Omosalewa Ogundipe
Title
Director
Phone
(813) 413-8258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X ME88205 FL Primary

Addresses

Primary practice location

10802 E. Main St
Ste B
Thonotosassa, FL 33592-2840

Mailing address

10802 E. Main Street,
Ste. B
Thonotossassa, FL 33592
Phone (813) 413-8258

National Provider Directory

National Provider Directory

Locations

10802 Main St
Ste B
Thonotosassa, FL 33592
Phone (813) 413-8258

NPI Registry JSON

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

{
    "created_epoch": "1263340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263340800000",
    "number": "1346570389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10802 E. MAIN STREET,",
            "address_2": "STE. B",
            "city": "THONOTOSSASSA",
            "state": "FL",
            "postal_code": "33592",
            "telephone_number": "813-413-8258",
            "fax_number": "813-413-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 E. MAIN ST",
            "address_2": "STE B",
            "city": "THONOTOSASSA",
            "state": "FL",
            "postal_code": "335922840",
            "telephone_number": "813-413-8258",
            "fax_number": "813-413-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-13",
        "last_updated": "2010-01-13",
        "status": "A",
        "authorized_official_last_name": "OGUNDIPE",
        "authorized_official_first_name": "OMOSALEWA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "813-413-8258",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME88205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thonotosassa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; 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.