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MAIN STREET MEDICAL PLLC NPI 1417230129


NPI Information

NPI: 1417230129
Provider Name: MAIN STREET MEDICAL, PLLC

Doing Business As: MAIN STREET MEDICINE

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
1667 OOLTEWAH RINGGOLD RD
OOLTEWAH, TN
ZIP 37363
Phone: (423) 886-7545
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MAIN STREET MEDICAL, PLLC is a specialist in Ooltewah, TN. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MAIN STREET MEDICAL, PLLC NPI is 1417230129. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Main Street Medicine.

The provider's business location address is:

1667 OOLTEWAH RINGGOLD RD
OOLTEWAH, TN
ZIP 37363-830
Phone: (423) 886-7545

The provider's authorized official is Paul A Miranda .
The authorized official title is Authorized User and has the following contact phone number (423) 521-5404.

The enumeration date for this NPI number is 9/20/2011 and was last updated on 2/9/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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