Main Street Family Practice Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

33966 Issued in TN

Legal business name

MAIN STREET FAMILY PRACTICE INC

Practice address

120 Main St
Portland, TN 37148-1218

Phone

(615) 323-8873

Fax

(615) 323-8874

NPI assigned

May 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stacey D Vance, M.D.NPI 1952300790

Title

President

Phone

(615) 323-8873

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacey Drott Vance, MD

  • Family Medicine Physician
  • Portland, TN
  • NPI 1952300790
  Authorized official Same address or phone

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952355372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MAIN ST",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481218",
            "telephone_number": "615-323-8873",
            "fax_number": "615-323-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MAIN ST",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481218",
            "telephone_number": "615-323-8873",
            "fax_number": "615-323-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY PRACTICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-323-8873",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "33966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis Albert Lee, PT, DPT
• Kristie Lenard, MSN, FNP-C
• Michael Dean Littell, DO
• LP Portland, LLC (Signature HealthCARE of Portland Rehab & Wellness Center)
• Lu Ponce MD PC
• Manley Counseling and Consulting PLLC
• Kristinna Marie Marowski, LPC/QMHP
• Brianna Kristine Martin
• Patrick Michael Maupin, PTA
• Heather Leanne McAmis, APRN, MSN, FNP-BC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.