Main Street Family Practice INC

NPI #1952355372 in Portland, Tennessee

Provider Information

NPI Number: 1952355372
Entity Type: Organization
Organization Name: Main Street Family Practice INC
Primary Specialty: Specialist
Enumeration Date: May 20, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 120 MAIN ST
City: Portland
State: Tennessee
ZIP Code: 37148-1218
Phone: (615) 323-8873

Authorized Official

Name: DR. STACEY D VANCE, M.D.
Title: PRESIDENT
Phone: (615) 323-8873

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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