Organization
MAIN STREET MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADOLPH MICHAEL WYCHULIS MD (OWNER)
(570) 462-1033
Entity
Organization
Contact information
Practice address
24 SOUTH MAIN STREET, SHENANDOAH, PA 17976
(570) 462-1033
(570) 462-1171
Mailing address
24 SOUTH MAIN STREET, SHENANDOAH, PA 17976
(570) 462-1033
(570) 462-1171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD418365
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019487500001
—
PA
Enumeration date
01/09/2007
Last updated
08/22/2020
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