Organization
SOUTHSIDE PHYSICIAN NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE AUSTIN (DIRECTOR)
(804) 765-5473
Entity
Organization
Contact information
Practice address
436 CLAIRMONT CT, SUITE 105, COLONIAL HEIGHTS, VA 23834
(804) 765-5473
(804) 765-6490
Mailing address
436 CLAIRMONT CT, SUITE 105, COLONIAL HEIGHTS, VA 23834-1765
(804) 765-5363
(804) 765-6490
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
VA
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
—
VA
2086S0129X
Vascular Surgery Physician
—
—
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
231H00000X
Audiologist
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811146194
—
VA
Enumeration date
09/11/2008
Last updated
11/15/2018
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