Main Street Minor Medical LLC

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

Legal business name

MAIN STREET MINOR MEDICAL LLC

Practice address

1121 1/2 N Main St
Shelbyville, TN 37160-2309

Phone

(931) 735-6003

Fax

(931) 735-6152

NPI assigned

Jul 18, 2019

Organization subpart

No

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

Authorized official

Name

Cristy D Ford

Title

Practice Manager

Phone

(931) 735-6003

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1700439734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 1/2 N MAIN ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371602309",
            "telephone_number": "931-735-6003",
            "fax_number": "931-735-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 1/2 N MAIN ST",
            "city": "SHELBYVILLE",
            "state": "TN",
            "postal_code": "371602309",
            "telephone_number": "931-735-6003",
            "fax_number": "931-735-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET MINOR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "CRISTY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "931-735-6003"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Lupo, LDO
• Lynette M Adams
• Madison Street Family Clinic
• Magnuson-Stimpson Medical Clinic
• Carol L. Magnuson, M.D.
• Christy Manning, PHARMD
• Savannah Manning
• Chris M. Marasco, M.D.
• Sarah Ann Marchetti
• Heather Markum, OTR/L

• Obesity Medicine (Family Medicine) Physician in Shelbyville, TN
• Providers in Shelbyville, TN by specialty
• Obesity Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.