NPI 1417230129
Main Street Medical, PLLC
Practice location
- Address
- 1667 Ooltewah Ringgold Rd, Ooltewah, TN 37363-9830
- Phone
- (423) 886-7545
- Mailing address
- 326 Creekshire Dr, Signal Mtn, TN 37377-2086
Authorised official
- Name
- Paul a Miranda
- Title
- Authorized User
- Phone
- (423) 521-5404
Registered specialties
Specialist
Primary
Registry record
- NPI
- 1417230129
- Entity type
- Organization
- NPI issued
- 20 Sep 2011
- Record last updated
- 9 Feb 2020
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.