Main Street Medical, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MAIN STREET MEDICAL, PLLC

Doing business as

Main Street Medicine

Practice address

1667 Ooltewah Ringgold Rd
Ooltewah, TN 37363-9830

Phone

(423) 886-7545

NPI assigned

Sep 20, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul A Miranda

Title

Authorized User

Phone

(423) 521-5404

Specialties & licenses 1

Addresses

Other names 1

• Main Street Medicine Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581206400000",
    "number": "1417230129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 CREEKSHIRE DR",
            "city": "SIGNAL MTN",
            "state": "TN",
            "postal_code": "373772086",
            "telephone_number": "423-243-8196",
            "fax_number": "417-429-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 OOLTEWAH RINGGOLD RD",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373639830",
            "telephone_number": "423-886-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-20",
        "last_updated": "2020-02-09",
        "certification_date": "2020-02-09",
        "status": "A",
        "authorized_official_last_name": "MIRANDA",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED USER",
        "authorized_official_telephone_number": "423-521-5404"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Main Street Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luna Dental Spa
• Ashley Rose Lynn, PA-C
• James Cooper Mabe, DPT
• Wendy Suzanne Macneill, OTR/L
• Ansley Johnson Madole
• Ian Mall
• Chelsea Manasco, FNP-C
• Joseph M Marangella, PT, DPT
• Obadias Marquez, MD
• Anna Moses Marsh, RDLD

• Specialist in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.