| Southside Family Clinic | |
|
107 Charles E Davis Blvd Nashville TN 37210 | |
| (615) 726-1807 | |
| (615) 712-1061 |
| Full Name | Southside Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Charles E Davis Blvd, Nashville, Tennessee |
| Authorized Official Name and Position | Brian Haile (CEO) |
| Authorized Official Contact | 6152273000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Family Clinic 2711 Foster Avenue Nashville TN 37210-5307 Ph: (615) 227-3000 | Southside Family Clinic 107 Charles E Davis Blvd Nashville TN 37210 Ph: (615) 726-1807 |
| NPI Number | 1740479674 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 02/12/2019 |
| Medicare PECOS PAC ID | 0042100091 |
|---|---|
| Medicare Enrollment ID | O20110225000835 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740479674 | NPI | - | NPPES |
| 3818145 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Tennessee) | Primary |
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