| South Side Medical Center | |
|
101 Cowardin Ave Suite 102 Richmond VA 23224-2078 | |
| (804) 780-0840 | |
| (804) 329-1206 |
| Full Name | South Side Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 Cowardin Ave, Richmond, Virginia |
| Authorized Official Name and Position | Tracy Causey (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8042531968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Side Medical Center 2809 North Ave Richmond VA 23222-3647 Ph: (804) 780-0840 | South Side Medical Center 101 Cowardin Ave Suite 102 Richmond VA 23224-2078 Ph: (804) 780-0840 |
| NPI Number | 1871818153 |
|---|---|
| Provider Enumeration Date | 03/30/2010 |
| Last Update Date | 11/17/2022 |
| Medicare PECOS PAC ID | 9638064850 |
|---|---|
| Medicare Enrollment ID | O20111011000463 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871818153 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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