North Main Medical, Llc | |
3094 N Mainst Crossville TN 38555 | |
(931) 644-5423 | |
(931) 337-0155 |
Full Name | North Main Medical, Llc |
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Speciality | Clinic/Center |
Location | 3094 N Mainst, Crossville, Tennessee |
Authorized Official Name and Position | Tamara Eroh (CREDENTIALING MANAGER) |
Authorized Official Contact | 9312002246 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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North Main Medical, Llc Po Box 3350 Crossville TN 38557-3350 Ph: () - | North Main Medical, Llc 3094 N Mainst Crossville TN 38555 Ph: (931) 644-5423 |
NPI Number | 1679106306 |
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Provider Enumeration Date | 02/21/2020 |
Last Update Date | 11/24/2020 |
Medicare PECOS PAC ID | 4688098767 |
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Medicare Enrollment ID | O20200722001546 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679106306 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Steven Pribanich |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912918343 PECOS PAC ID: 3375632961 Enrollment ID: I20090622000702 |
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