NPIMap

Organization Active NPI

Mainstreet and Kidsstreet of North Carolina PLLC

  • Rural Health Clinic/Center
  • Tarboro, NC
National Provider Identifier
1740076504
Registry record updated Mar 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC
Practice address
110 Western Blvd
Tarboro, NC 27886-4858
Phone
(252) 774-4250
NPI assigned
Apr 17, 2025
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Krista Rock
Title
VP
Phone
(205) 545-5090

Owners & managing parties with NPI records 22

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 22

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 76

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

View all 76

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Rural health clinic certification: CCN 343819

Medicare enrollment files
Legal name
MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC
Doing business as
MAINSTREET FAMILY CARE - TARBORO
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 18, 2026
Last certification
May 18, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
110 Western Blvd
Tarboro, NC 27886-4858

All disclosed owners & managing parties 2

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Timothy Pattison Taylor Individual 5% Or Greater Direct Ownership Interest Sep 1, 2015 100%
Corporate Officer Sep 4, 2025
Corporate Director Sep 4, 2025
W-2 Managing EmployeeMD; Sep 4, 2025
Rural Urgent Care LLC Organization, Birmingham, AL LLC Operational/Managerial Control Apr 15, 2021 100%

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20260217003383 NC Part a Provider - Rural Health Clinic 6901290238 Practice locations: Tarboro, NC

National Provider Directory

National Provider Directory
Tax ID family
Mainstreet and Kidsstreet of North Carolina PLLC (35 organizations share this tax ID)

Locations

110 Western Blvd
Tarboro, NC 27886
Phone (252) 774-4250

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

110 Western Blvd
Tarboro, NC 27886-4858

Mailing address

1500 1St Ave N Unit 3
Birmingham, AL 35203-1866
Phone (205) 545-5085

Other names 1

NPPES NPI Registry
  • MainStreet Family Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 20, 2026.

{
    "created_epoch": "1744848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1740076504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 1ST AVE N UNIT 3",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352031866",
            "telephone_number": "205-545-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 WESTERN BLVD",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278864858",
            "telephone_number": "252-774-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINSTREET AND KIDSSTREET OF NORTH CAROLINA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-17",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "205-545-5090"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MainStreet Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tarboro, NC

Sources for this page

Verify at the official NPI Registry.