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General NPI Number Information
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NPI Number | 1003099409
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE MEDICAL CENTER PA
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1925A OLEANDER DR
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City | WILMINGTON
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State | NC
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Zip | 28403-2334
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Country | US
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Telephone | 910-251-7715
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Fax | 910-763-7845
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | HOLLY RIDGE
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State | NC
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Zip | 28445-0129
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Country | US
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Telephone | 910-264-2334
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Fax | 910-763-7845
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES HENRY PRIDGEN
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Credential | M.D.
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Telephone | 910-264-2334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29495
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License Number State | NC
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