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General NPI Number Information
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NPI Number | 1841474236
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE ORTHOPEDIC ASSOCIATES, PC
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 1509 WEST THIRD ST
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-8849
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Fax | 434-392-3280
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Provider Business Mailing Address
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Address Line | 1509 WEST THIRD ST
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-8849
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Fax | 434-392-3280
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CANDI MAHAN
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Credential |
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Telephone | 434-392-8849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101023902
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License Number State | VA
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