# MAIN STREET MEDICAL CLINIC, P.A.

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

## Provider details

- **NPI number:** 1841298791
- **Authorized official:** SHERYL WILCHMAN (OFFICE MANAGER)
- **Authorized official phone:** (501) 315-0059

## Contact information

- **Practice address:** 722 N MAIN ST, BENTON, AR 72015-3337
- **Practice address phone:** (501) 315-0059
- **Practice address fax:** (501) 315-1320
- **Mailing address:** 722 N MAIN ST, BENTON, AR 72015-3337
- **Mailing address phone:** (501) 315-0059
- **Mailing address fax:** (501) 315-1320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MC-2252 | AR | Yes |
| 208000000X | Pediatrics Physician | MC-2252 | AR | — |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 05/20/2021