Organization
NORTHSIDE MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT W. THEAKSTON M.D. (PRESIDENT)
(256) 845-9355
Entity
Organization
Contact information
Practice address
211 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3755
(256) 845-9355
Mailing address
PO BOX 680047, FORT PAYNE, AL 35968-1601
(256) 845-9355
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/02/2008
Last updated
11/02/2008
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