Main Street DME, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MAIN STREET DME, INC.

Practice address

2959 Cherokee St NW Ste 103C
Kennesaw, GA 30144-6522

Phone

(678) 387-5620

Fax

(678) 638-2857

NPI assigned

Aug 14, 2023

Organization subpart

No

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

Authorized official

Name

Jason Yuri Onoufrienko

Title

Owner

Phone

(678) 387-5620

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1689457772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2959 CHEROKEE ST NW STE 103C",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301446522",
            "telephone_number": "678-387-5620",
            "fax_number": "678-638-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2959 CHEROKEE ST NW STE 103C",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301446522",
            "telephone_number": "678-387-5620",
            "fax_number": "678-638-2857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "ONOUFRIENKO",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "YURI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-387-5620"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.