South Main Clinic LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SOUTH MAIN CLINIC LLC

Practice address

1913 S Main St
Madisonville, KY 42431-3353

Phone

(270) 404-3411

NPI assigned

May 31, 2019

Organization subpart

No

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

Authorized official

Name

Dr. James Bradley Ashby, PHARMD

Title

Vice-President/Member

Phone

(270) 404-3411

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN B03820

Legal name

SOUTH MAIN CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jun 1, 2020

Last certification

Jun 1, 2020

Ownership / control type

1B

Facility address

1913 S Main St
Madisonville, KY 42431

Locations

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593561600000",
    "number": "1851959217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 S MAIN ST",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424313353",
            "telephone_number": "270-404-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1913 S MAIN ST",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424313353",
            "telephone_number": "270-404-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MAIN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-31",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A",
        "authorized_official_last_name": "ASHBY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BRADLEY",
        "authorized_official_title_or_position": "VICE-PRESIDENT/MEMBER",
        "authorized_official_telephone_number": "270-404-3411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851959217",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanner Smith
• William F. Smith III, M.D.
• Samantha J Snyder, CSA
• Alejandro L Soriano, MD
• Sandra Alexis Soriano, PA-C
• Carla South
• Denise H Sparks, APRN
• Summer Sparks, MEDICAL STUDENT
• Suzanne Segebarth Spencer, DMD
• Lori Whitnell Spraggs, RD, LD

• Rural Health Clinic/Center in Madisonville, KY
• Providers in Madisonville, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.