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Organization
MAIN STREET MEDICAL LLC
Active
Organization
MAIN STREET MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHUCK NEWHOUSE MD (OWNER)
(208) 265-3655
Entity
Organization
Contact information
Practice address
6641 KANIKSU ST, SUITE A, BONNERS FERRY, ID 83805-7532
(208) 265-3655
(208) 267-3757
Mailing address
PO BOX 1640, BONNERS FERRY, ID 83805-1640
(208) 265-3655
(208) 267-3757
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-7989
ID
Other
Enumeration date
01/23/2007
Last updated
02/22/2008
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