# SOUTHSIDE MEDICAL CENTER PA

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

## Provider details

- **NPI number:** 1972782019
- **Authorized official:** DR. THAER JOUDEH MD (OWNER)
- **Authorized official phone:** (864) 288-2006

## Contact information

- **Practice address:** 3921 S HIGHWAY 14 STE A, GREENVILLE, SC 29615-6138
- **Practice address phone:** (864) 288-2006
- **Practice address fax:** (864) 288-1678
- **Mailing address:** 3921 S HIGHWAY 14 STE A, GREENVILLE, SC 29615-6138
- **Mailing address phone:** (864) 288-2006
- **Mailing address fax:** (864) 288-1678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 21696 | SC | Yes |

## Other

- **Enumeration date:** 10/25/2007
- **Last updated:** 10/25/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 216965 | — | SC |