NPIMap

Organization Active NPI

Main Street Clinic, LLC

  • Pediatrics Physician
  • Pell City, AL
National Provider Identifier
1740895291
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MAIN STREET CLINIC, LLC
Practice address
1508 Cogswell Ave
Pell City, AL 35125-1243
Phone
(205) 338-7866
Fax
(205) 778-4318
NPI assigned
Sep 11, 2020
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Muhammad E Ata, MDNPI 1023112307
Title
Owner
Phone
(205) 338-7866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1508 Cogswell Ave
Pell City, AL 35125-1243

Mailing address

1508 Cogswell Ave
Pell City, AL 35125-1243

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200928003287 AL Part B Supplier - Clinic/Group Practice 6002235801 Receives reassigned benefits from 12 practitioners
Practice locations: Pell City, AL
O20201203000100 AL Part A Provider - Rural Health Clinic 6002235801 Practice locations: Pell City, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740895291. Details of each certification follow.

Rural health clinic certification: CCN 018951

Legal name
MAIN STREET CLINIC, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 22, 2021
Last certification
Mar 22, 2021
Ownership / control type
1C
Organization structure
LLCProprietary
Enrollment address
2850 Dr John Haynes Dr
Pell City, AL 35125-1438

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2190669Main Street Clinic LLC2850 Dr John Haynes Drive, Pell City, AL 35125Certificate of waiverAug 17, 2026

National Provider Directory

National Provider Directory

Locations

1508 Cogswell Ave
Pell City, AL 35125
Phone (205) 814-1598

609 Main St
Ste 2
Hazard, KY 41701

10015 Main St
Whitesville, KY 42378
Phone (270) 233-1884

341 E State Rt 4
Paramus, NJ 07652
Phone (201) 489-4500

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Muhammad Ata Individual 5% Or Greater Direct Ownership Interest Aug 11, 2020 60%
Corporate OfficerPresident Aug 11, 2020 60%
Operational/Managerial Control Aug 11, 2020 60%
Zaheer a Khan Individual 5% Or Greater Direct Ownership Interest Aug 11, 2020 40%
Corporate OfficerVice President Aug 11, 2020 40%
Operational/Managerial Control Aug 11, 2020 40%

Owners & managing parties with NPI records 2

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

  • Muhammad Ejaz Ata
    • Internal Medicine Physician
    • Pisgah, AL
    • NPI 1023112307

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership
  • Zaheer A Khan, M.D.
    • Internal Medicine Physician
    • Huntsville, AL
    • NPI 1669454351

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1740895291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 COGSWELL AVE",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351251243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 COGSWELL AVE",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351251243",
            "telephone_number": "205-338-7866",
            "fax_number": "205-778-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "ATA",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-338-7866",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pell City, AL

Sources for this page

Verify at the official NPI Registry.