# MAIN STREET FAMILY CLINIC LLC

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

## Provider details

- **NPI number:** 1275326191
- **Authorized official:** BETH HOLDERBY APRN (OWNER)
- **Authorized official phone:** (580) 551-9131

## Contact information

- **Practice address:** 213 W MAIN ST, CANTON, OK 73724-1234
- **Practice address phone:** (405) 506-9101
- **Practice address fax:** (405) 936-0561
- **Mailing address:** PO BOX 57390, OKLAHOMA CITY, OK 73157-7390
- **Mailing address phone:** (405) 506-9101
- **Mailing address fax:** (405) 936-0561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/23/2025
- **Last updated:** 07/09/2025