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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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