| Main Street Family Medicine ,llc | |
|
1336 E Main St Columbus OH 43205-2081 | |
| (614) 253-8537 | |
| (614) 253-8539 |
| Full Name | Main Street Family Medicine ,llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1336 E Main St, Columbus, Ohio |
| Authorized Official Name and Position | Chandre C Gowda (PHYSICIAN) |
| Authorized Official Contact | 6142538537 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Medicine ,llc 881 E Main St Columbus OH 43205-1713 Ph: (614) 253-8537 | Main Street Family Medicine ,llc 1336 E Main St Columbus OH 43205-2081 Ph: (614) 253-8537 |
| NPI Number | 1922163575 |
|---|---|
| Provider Enumeration Date | 12/26/2006 |
| Last Update Date | 05/14/2015 |
| Medicare PECOS PAC ID | 2264432996 |
|---|---|
| Medicare Enrollment ID | O20070103000396 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922163575 | NPI | - | NPPES |
| 2606415 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35085235 (Ohio) | Primary |
| Provider Name | Chandre C Gowda |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235162322 PECOS PAC ID: 7416986195 Enrollment ID: I20050812000169 |
| Provider Name | Messeret Tewolde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114364668 PECOS PAC ID: 2567606023 Enrollment ID: I20130924000031 |
| Provider Name | Lynsey Diersing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043744535 PECOS PAC ID: 4688087810 Enrollment ID: I20210107002816 |
| Provider Name | Misty Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295370054 PECOS PAC ID: 3274903935 Enrollment ID: I20221221002977 |
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