Organization
SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Active
Other names
Southside Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANN CAZABAN JR. (EXECUTIVE DIRECTOR)
(612) 821-2025
Entity
Organization
Contact information
Practice address
324 E 35TH ST, MINNEAPOLIS, MN 55408-4580
(612) 827-7181
(612) 827-6403
Mailing address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 821-2799
(612) 821-2818
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343814700
—
MN
Enumeration date
03/14/2006
Last updated
12/10/2024
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