Organization
NORTHSIDE ONSITE MEDICAL SERVICES, INC.
Active
Parent organization
NORTHSIDE MEDICAL, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHSIDE MEDICAL, INC.
Authorized official
DR. ROBERT THEAKSTON M.D. (PRESIDENT)
(256) 845-9355
Entity
Organization
Contact information
Practice address
106 45TH ST NE, FORT PAYNE, AL 35967-4010
(256) 304-2109
Mailing address
211 GREENHILL BLVD NW, FORT PAYNE, AL 35967-3755
(256) 845-9355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/27/2014
Last updated
05/28/2014
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