Organization
SOUTHSIDE MEDICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THAER JOUDEH MD (OWNER)
(864) 288-2006
Entity
Organization
Contact information
Practice address
3921 S HIGHWAY 14 STE A, GREENVILLE, SC 29615-6138
(864) 288-2006
(864) 288-1678
Mailing address
3921 S HIGHWAY 14 STE A, GREENVILLE, SC 29615-6138
(864) 288-2006
(864) 288-1678
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
21696
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
216965
—
SC
Enumeration date
10/25/2007
Last updated
10/25/2007
Update your record
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