MEDICARE: NORTH MAIN MEDICAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1679106306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH MAIN MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3350
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38557-3350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 MATHERLY ST
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-1001
Country	:	US
Telephone Number	:	931-644-5423
Fax Number	:	931-710-5728

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	GINA R LEARY
Credential	:
Telephone Number	:	931-248-1414

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	05/18/2026

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