Organization
SOUTHSIDE MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE WAYNE MELVIN (EXECUTIVE DIRECTOR)
(618) 242-2745
Entity
Organization
Contact information
Practice address
913 SOUTH 10TH STREET, MOUNT VERNON, IL 62864-5313
(618) 242-2745
(618) 242-2766
Mailing address
913 SOUTH 10TH STREET, MOUNT VERNON, IL 62864-5313
(618) 242-2745
(618) 242-2766
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
001
IL
Other
Enumeration date
11/30/2006
Last updated
07/21/2022
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