Provider Demographics
NPI:1649620048
Name:MAIN MEDICAL INC
Entity type:Organization
Organization Name:MAIN MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:918-963-2161
Mailing Address - Street 1:27096 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:SHADY POINT
Mailing Address - State:OK
Mailing Address - Zip Code:74956-2186
Mailing Address - Country:US
Mailing Address - Phone:918-963-2161
Mailing Address - Fax:918-963-2489
Practice Address - Street 1:26256 CAUGHRON RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:OK
Practice Address - Zip Code:74932-2376
Practice Address - Country:US
Practice Address - Phone:918-963-2161
Practice Address - Fax:918-963-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization