Organization
SOUTHSIDE UROLOGY CLINIC PC
Active
Other names
The Southside Urology Clinic, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES D TAYLOR MD (OWNER /PRESIDENT)
(434) 392-9449
Entity
Organization
Contact information
Practice address
800 OAK ST, FARMVILLE, VA 23901-1199
(434) 392-9449
(434) 392-5530
Mailing address
PO BOX 347, FARMVILLE, VA 23901-0347
(434) 392-9449
(434) 392-5530
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101037122
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528066297
PHYSICIAN NPI
—
05
—
1528066297
—
VA
01
—
340001025
RAILROAD MEDICARE PIN
—
01
—
CM5051
RAILROAD MEDICARE GROUP #
—
Enumeration date
04/11/2007
Last updated
01/04/2011
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