# SOUTHSIDE MEDICAL CLINIC

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

## Provider details

- **NPI number:** 1194937235
- **Authorized official:** DR. THUYLINH PHAM MD (CEO)
- **Authorized official phone:** (870) 424-5079

## Contact information

- **Practice address:** 623 S 21ST ST, FORT SMITH, AR 72901-3914
- **Practice address phone:** (479) 441-1500
- **Practice address fax:** (479) 441-1502
- **Mailing address:** PO BOX 310, MOUNTAIN HOME, AR 72654-0310
- **Mailing address phone:** (870) 424-0899
- **Mailing address fax:** (870) 424-8455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | E1751 | AR | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 08/22/2020