# MAIN STREET MINOR MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700439734
- **Authorized official:** CRISTY D FORD (PRACTICE MANAGER)
- **Authorized official phone:** (931) 735-6003

## Contact information

- **Practice address:** 1121 1/2 N MAIN ST, SHELBYVILLE, TN 37160-2309
- **Practice address phone:** (931) 735-6003
- **Practice address fax:** (931) 735-6152
- **Mailing address:** 1121 1/2 N MAIN ST, SHELBYVILLE, TN 37160-2309
- **Mailing address phone:** (931) 735-6003
- **Mailing address fax:** (931) 735-6152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2019
- **Last updated:** 07/18/2019