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General NPI Number Information
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NPI Number | 1831016872
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Entity Type | Organization
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Legal Business Name | MAIN ST MEDICAL SUPPLY
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 102 E MAIN ST
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City | DECHERD
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State | TN
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Zip | 37324-3000
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Country | US
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Telephone | 931-808-7498
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Fax |
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Provider Business Mailing Address
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Address Line | 2808 OLD ALTO HWY
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City | DECHERD
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State | TN
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Zip | 37324-3203
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Country | US
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Telephone | 931-808-7498
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA JACKSON
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Credential |
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Telephone | 731-445-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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