# MAIN STREET FAMILY MEDICINE PLLC

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

## Provider details

- **NPI number:** 1518636844
- **Authorized official:** COLTEN DIRK BRACKEN MD (MD/OWNER)
- **Authorized official phone:** (435) 878-5711

## Contact information

- **Practice address:** 571 EAST MAIN STREET, ENTERPRISE, UT 84725
- **Practice address phone:** (435) 878-5711
- **Mailing address:** 571 EAST MAIN STREET, ENTERPRISE, UT 84725
- **Mailing address phone:** (435) 878-5711

## Taxonomy

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

## Other

- **Enumeration date:** 09/09/2021
- **Last updated:** 10/29/2021