Organization
MAIN STREET FAMILY PRACTICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY D VANCE M.D. (PRESIDENT)
(615) 323-8873
Entity
Organization
Contact information
Practice address
120 MAIN ST, PORTLAND, TN 37148-1218
(615) 323-8873
(615) 323-8874
Mailing address
120 MAIN ST, PORTLAND, TN 37148-1218
(615) 323-8873
(615) 323-8874
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
33966
TN
Other
Enumeration date
05/20/2006
Last updated
08/22/2020
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