| Southside Family Medical Group, Llc | |
|
5955 S Emerson Ave Suite 100 Indianapolis IN 46237-2600 | |
| (317) 789-9600 | |
| (317) 789-0600 |
| Full Name | Southside Family Medical Group, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5955 S Emerson Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Chris A Goul (PRACTICE MANAGER) |
| Authorized Official Contact | 3174528400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Family Medical Group, Llc 5955 S Emerson Ave Suite 100 Indianapolis IN 46237-2600 Ph: (317) 452-8400 | Southside Family Medical Group, Llc 5955 S Emerson Ave Suite 100 Indianapolis IN 46237-2600 Ph: (317) 789-9600 |
| NPI Number | 1215024674 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 10/07/2015 |
| Medicare PECOS PAC ID | 2567431869 |
|---|---|
| Medicare Enrollment ID | O20041001000768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215024674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David Dale Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164490538 PECOS PAC ID: 8527012913 Enrollment ID: I20050309000215 |
| Provider Name | Rhonda Wilson Goul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023086725 PECOS PAC ID: 5890749287 Enrollment ID: I20050309000248 |
| Provider Name | Cynthia S Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093756348 PECOS PAC ID: 5193725828 Enrollment ID: I20070103000376 |
| Provider Name | Brian C Ruley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386758639 PECOS PAC ID: 3476652975 Enrollment ID: I20070625000405 |
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