Organization
MAIN STREET CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAUREN LINN MILLER FNP-BC (OWNER)
(435) 835-6000
Entity
Organization
Contact information
Practice address
46 N MAIN ST, MANTI, UT 84642-1254
(435) 835-6000
(435) 835-6004
Mailing address
46 N MAIN ST, MANTI, UT 84642-1254
(435) 835-6000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2158984405
UT
Other
Enumeration date
05/24/2013
Last updated
05/24/2013
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