# SOUTHSIDE FAMILY CLINIC LLC

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

## Provider details

- **NPI number:** 1720508955
- **Authorized official:** JOHN DIES FNP-C (PRESIDENT)
- **Authorized official phone:** (337) 580-4061

## Contact information

- **Practice address:** 304 N HOSPITAL DR STE A, ABBEVILLE, LA 70510-4041
- **Practice address phone:** (337) 580-4061
- **Mailing address:** 304 N HOSPITAL DR STE A, ABBEVILLE, LA 70510-4041
- **Mailing address phone:** (337) 385-1972
- **Mailing address fax:** (337) 385-2849

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/20/2017
- **Last updated:** 04/28/2018