# ROADSIDE MEDICAL, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Roadside Medical Clinic and Lab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457665382
- **Authorized official:** JONATHON WITHERSPOON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (941) 225-2520

## Contact information

- **Practice address:** 699 STATE ROUTE 203, SUITE 1, EAST SAINT LOUIS, IL 62201-1608
- **Practice address phone:** (941) 225-2520
- **Practice address fax:** (888) 860-8609
- **Mailing address:** 8466 LOCKWOOD RIDGE RD, \#248, SARASOTA, FL 34243-2951
- **Mailing address phone:** (941) 225-2520
- **Mailing address fax:** (888) 860-8609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/03/2010
- **Last updated:** 08/03/2010