Organization
SOUTHSIDE PHYSICIAN NETWORK LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up