| Main Street Family Medicine Inc | |
|
1306 Us Highway 45 N Henderson TN 38340-4003 | |
| (731) 989-9899 | |
| (731) 989-3495 |
| Full Name | Main Street Family Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1306 Us Highway 45 N, Henderson, Tennessee |
| Authorized Official Name and Position | Paul Edward Schwartz (OWNER) |
| Authorized Official Contact | 7319899899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Medicine Inc 1306 Us Highway 45 N Henderson TN 38340-4003 Ph: (731) 989-9899 | Main Street Family Medicine Inc 1306 Us Highway 45 N Henderson TN 38340-4003 Ph: (731) 989-9899 |
| NPI Number | 1538191135 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 02/23/2011 |
| Medicare PECOS PAC ID | 8022039718 |
|---|---|
| Medicare Enrollment ID | O20051209000044 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538191135 | NPI | - | NPPES |
| 3731842 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Paul E Schwartz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396770731 PECOS PAC ID: 0749208379 Enrollment ID: I20051102000865 |
| Provider Name | Randle S Miskelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013948066 PECOS PAC ID: 2365452851 Enrollment ID: I20060427000692 |
| Provider Name | Jessica Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164872917 PECOS PAC ID: 4082970520 Enrollment ID: I20171115003606 |
| Provider Name | Sara Massey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578210407 PECOS PAC ID: 8022482231 Enrollment ID: I20230329001549 |
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