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NPI Code Detail

MEDICARE: SOUTHSIDE COMMUNITY HOSPITAL, INC.

MEDICARE: SOUTHSIDE COMMUNITY HOSPITAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care HospitalH1904VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518952761
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE COMMUNITY HOSPITAL, INC.
Provider Business Mailing Address
First Line : 800 OAK ST
Second Line :
City : FARMVILLE
State : VA
Zip : 23901-1199
Country : US
Telephone Number : 434-392-8811
Fax Number : 434-315-2463
Provider Business Practice Location Address
First Line : 800 OAK ST
Second Line :
City : FARMVILLE
State : VA
Zip : 23901-1199
Country : US
Telephone Number : 434-392-8811
Fax Number : 434-315-2463
Authorized Official
Title or Position : CFO
Name : DOUG DAVENPORT
Credential :
Telephone Number : 434-200-4708
Provider Enumeration Date : 09/14/2005
Last Update Date : 01/27/2022

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