Main Street Addiction Center Inc

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

1489 Issued in WV

Legal business name

MAIN STREET ADDICTION CENTER INC

Practice address

204 Main St
Logan, WV 25601-3944

Phone

(304) 752-3400

Fax

(304) 752-3400

NPI assigned

Jan 24, 2017

Organization subpart

No

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

Authorized official

Name

Kenneth W. Sells, D.O.

Title

Owner

Phone

(304) 752-3400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1639616006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MAIN ST",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013944",
            "telephone_number": "304-752-3400",
            "fax_number": "304-752-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MAIN ST",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013944",
            "telephone_number": "304-752-3400",
            "fax_number": "304-752-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET ADDICTION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "SELLS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-752-3400",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "WV",
            "license": "1489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Lucas, D.O.
• Lonnie Kent Lucas Sr., O.D.
• Erica Lupson, APRN
• Candace Leigh Lusk, COTA
• Hobert L Mack, DDS
• Main Street Family Practice, Inc
• Kozhaya Mallah, MD
• Mamidi Cardiology PLLC
• Kerri Mangus
• Zachary Manley, FNP-C

• Addiction Medicine (Family Medicine) Physician in Logan, WV
• Providers in Logan, WV by specialty
• Addiction Medicine (Family Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.