# SOUTH SIDE CONVENIENT CARE INC

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

## Provider details

- **NPI number:** 1679007249
- **Authorized official:** MRS. SAMANTHA SENANAYAKA PA-C (CLINIC CREDENTIALING CONTACT)
- **Authorized official phone:** (402) 350-7616

## Contact information

- **Practice address:** 4115 HARRISON ST, BELLEVUE, NE 68147-1059
- **Practice address phone:** (402) 932-0692
- **Practice address fax:** (402) 614-6731
- **Mailing address:** 4115 HARRISON ST, BELLEVUE, NE 68147-1059
- **Mailing address phone:** (402) 932-0692
- **Mailing address fax:** (402) 614-6731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2017
- **Last updated:** 07/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10026666300 | — | NE |