# MAIN STREET MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134274103
- **Authorized official:** DR. CHUCK NEWHOUSE MD (OWNER)
- **Authorized official phone:** (208) 265-3655

## Contact information

- **Practice address:** 6641 KANIKSU ST, SUITE A, BONNERS FERRY, ID 83805-7532
- **Practice address phone:** (208) 265-3655
- **Practice address fax:** (208) 267-3757
- **Mailing address:** PO BOX 1640, BONNERS FERRY, ID 83805-1640
- **Mailing address phone:** (208) 265-3655
- **Mailing address fax:** (208) 267-3757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M-7989 | ID | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 02/22/2008