| Main Street Minor Medical Llc | |
|
1121 1/2 N Main St Shelbyville TN 37160-2309 | |
| (931) 735-6003 | |
| (931) 735-6152 |
| Full Name | Main Street Minor Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1121 1/2 N Main St, Shelbyville, Tennessee |
| Authorized Official Name and Position | Cristy D Ford (PRACTICE MANAGER) |
| Authorized Official Contact | 9317356003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Minor Medical Llc 1121 1/2 N Main St Shelbyville TN 37160-2309 Ph: (931) 735-6003 | Main Street Minor Medical Llc 1121 1/2 N Main St Shelbyville TN 37160-2309 Ph: (931) 735-6003 |
| NPI Number | 1700439734 |
|---|---|
| Provider Enumeration Date | 07/18/2019 |
| Last Update Date | 07/18/2019 |
| Medicare PECOS PAC ID | 8820320625 |
|---|---|
| Medicare Enrollment ID | O20191029000000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700439734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QB0002X | Family Medicine - Obesity Medicine | (* (Not Available)) | Primary |
| Provider Name | Katherine Helen Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427462043 PECOS PAC ID: 5496975567 Enrollment ID: I20180426002604 |
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