Provider Demographics
NPI:1396919940
Name:MAIN STREET HEALTH ASSOCIATES PC
Entity type:Organization
Organization Name:MAIN STREET HEALTH ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:ARGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-655-4404
Mailing Address - Street 1:135 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:570-655-4404
Mailing Address - Fax:570-655-4562
Practice Address - Street 1:135 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-655-4404
Practice Address - Fax:570-655-4562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAIN STREET HEALTH ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013491L225100000X
PADC007061L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013095920001Medicaid
PA01654591Medicaid
PA01654591Medicaid
PA093404UG1Medicare PIN
PA1013095920001Medicaid
PAU68417Medicare UPIN