Organization
CHRISTY R NEWBAKER
Active
Other names
MAIN STREET VITAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY R NEWBAKER (OWNER)
(731) 627-2221
Entity
Organization
Contact information
Practice address
126 EAST MAIN STREET, NEWBERN, TN 38059
(731) 627-2221
(731) 627-6152
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000000895
TN
332BC3200X
Customized Equipment (DME)
0000000895
TN
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
0000000895
TN
332BX2000X
Oxygen Equipment & Supplies (DME)
0000000895
TN
333600000X
Pharmacy
0000000895
TN
3336C0003X
Community/Retail Pharmacy
0000000895
TN
3336H0001X
Home Infusion Therapy Pharmacy
0000000895
TN
3336L0003X
Long Term Care Pharmacy
0000000895
TN
3336M0002X
Mail Order Pharmacy
0000000895
TN
3336S0011X
Specialty Pharmacy
0000000895
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454920
—
TN
01
—
164127
TENNCARE
TN
01
—
4102341
BCBS SPECIALTY DME
TN
01
—
4102343
BCBS HIT
TN
05
—
895
—
TN
Enumeration date
09/11/2006
Last updated
04/20/2008
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