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General NPI Number Information
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NPI Number | 1679106306
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Entity Type | Organization
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Legal Business Name | NORTH MAIN MEDICAL, LLC
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 3094 N MAINST
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City | CROSSVILLE
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State | TN
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Zip | 38555
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Country | US
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Telephone | 931-644-5423
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Fax | 931-337-0155
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Provider Business Mailing Address
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Address Line | PO BOX 3350
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City | CROSSVILLE
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State | TN
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Zip | 38557-3350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TAMARA EROH
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Credential |
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Telephone | 931-200-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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