Provider Demographics
NPI:1831906908
Name:MAIN STREET MEDICAL LLC
Entity type:Organization
Organization Name:MAIN STREET MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:308-220-8082
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:NE
Mailing Address - Zip Code:69154-6112
Mailing Address - Country:US
Mailing Address - Phone:308-772-0164
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:NE
Practice Address - Zip Code:69154-6112
Practice Address - Country:US
Practice Address - Phone:308-772-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty