Organization
MAIN STREET FAMILY MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH TRUDY DAVIS APRN-CNP (FOUNDER)
(918) 448-7854
Entity
Organization
Contact information
Practice address
701 W BROADWAY ST, SPIRO, OK 74959-2456
(918) 962-8009
(918) 962-8027
Mailing address
32415 PEACH CREEK RD, RED OAK, OK 74563-1101
(918) 448-7854
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2022
Last updated
09/07/2023
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