Main Street Medical LLC
NPI #1134274103 in Bonners Ferry, Idaho
Provider Information
- NPI Number
- 1134274103
- Entity Type
- Organization
- Organization Name
- Main Street Medical LLC
- Primary Specialty
- Family Medicine
- Enumeration Date
- Jan 23, 2007
- Last Updated
- Feb 22, 2008
Practice Location
- Address
- 6641 KANIKSU ST
- Address 2
- SUITE A
- City
- Bonners Ferry
- State
- Idaho
- ZIP Code
- 83805-7532
- Phone
- (208) 265-3655
Authorized Official
- Name
- DR. CHUCK NEWHOUSE, MD
- Title
- OWNER
- Phone
- (208) 265-3655
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine |
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