Healthcare Provider Details

I. General information

NPI: 1376409276
Provider Name (Legal Business Name): SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E LAKE ST
MINNEAPOLIS MN
55407-1617
US

IV. Provider business mailing address

1000 E LAKE ST
MINNEAPOLIS MN
55407-1617
US

V. Phone/Fax

Practice location:
  • Phone: 612-822-9030
  • Fax: 612-821-2818
Mailing address:
  • Phone: 612-822-9030
  • Fax: 612-821-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANN CAZABAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 612-827-7181