Healthcare Provider Details

I. General information

NPI: 1861447732
Provider Name (Legal Business Name): SOUTH HILL FAMILY MEDICINE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W ATLANTIC ST
SOUTH HILL VA
23970-1906
US

IV. Provider business mailing address

514 W ATLANTIC ST
SOUTH HILL VA
23970-1906
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-6969
  • Fax: 434-447-2240
Mailing address:
  • Phone: 434-447-6969
  • Fax: 434-447-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: JOAN S MEDLIN
Title or Position: EXE ASST
Credential:
Phone: 434-447-6969