1710056387 NPI number — SOUTHSIDE COMMUNITY HOSPITAL INC.

Table of content: (NPI 1710056387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710056387 NPI number — SOUTHSIDE COMMUNITY HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHSIDE COMMUNITY HOSPITAL INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710056387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23901-1199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-315-2550
Provider Business Mailing Address Fax Number:
434-315-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23901-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-315-2550
Provider Business Practice Location Address Fax Number:
434-315-2551
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVENPORT
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
434-200-4708

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004970551 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20066 . This is a "OPTIMA FAMILY CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 59075 . This is a "CARENET(MEDICAID HMO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 780021 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1520 . This is a "GENTIVA CARECENTRIX" identifier . This identifiers is of the category "OTHER".




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