Organization
SOUTHSIDE INTERNAL MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUKE SAN M.D. (M.D.)
(434) 392-6143
Entity
Organization
Contact information
Practice address
202 AGEE STREET, FARMVILLE, VA 23901
(434) 392-6143
(434) 392-3866
Mailing address
202 AGEE STREET, FARMVILLE, VA 23901
(434) 392-6143
(434) 392-3866
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
0101048599
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005849632
—
VA
Enumeration date
10/18/2007
Last updated
01/19/2010
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