NPIMap

Organization Active NPI

Main Street Medical PLLC

  • Family Medicine Physician
  • Barboursville, WV
National Provider Identifier
1801125752
Registry record updated Dec 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10652 Issued in WV
Legal business name
MAIN STREET MEDICAL PLLC
Practice address
650 Main St
Barboursville, WV 25504-1439
Phone
(304) 733-6484
Fax
(304) 733-6486
NPI assigned
Dec 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2009

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

Authorized official

Name
Robert B Walker, M.D.
Title
President
Phone
(304) 733-6484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 10652 WV Primary

Addresses

Primary practice location

650 Main St
Barboursville, WV 25504-1439

Mailing address

650 Main St
Barboursville, WV 25504-1439
Phone (304) 733-6484

Other identifiers 1

IdentifierTypeStateIssuer
0056287000MedicaidWV

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1261526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261526400000",
    "number": "1801125752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 MAIN ST",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041439",
            "telephone_number": "304-733-6484",
            "fax_number": "304-733-6486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 MAIN ST",
            "city": "BARBOURSVILLE",
            "state": "WV",
            "postal_code": "255041439",
            "telephone_number": "304-733-6484",
            "fax_number": "304-733-6486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-23",
        "last_updated": "2009-12-23",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-733-6484",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "10652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056287000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Barboursville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2009; 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.