| Southside Medical Center Pa | |
|
3921 S Highway 14 Ste A Greenville SC 29615-6138 | |
| (864) 288-2006 | |
| (864) 288-1678 |
| Full Name | Southside Medical Center Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 3921 S Highway 14 Ste A, Greenville, South Carolina |
| Authorized Official Name and Position | Thaer Joudeh (OWNER) |
| Authorized Official Contact | 8642882006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Center Pa 3921 S Highway 14 Ste A Greenville SC 29615-6138 Ph: (864) 288-2006 | Southside Medical Center Pa 3921 S Highway 14 Ste A Greenville SC 29615-6138 Ph: (864) 288-2006 |
| NPI Number | 1972782019 |
|---|---|
| Provider Enumeration Date | 10/25/2007 |
| Last Update Date | 10/25/2007 |
| Medicare PECOS PAC ID | 5496703274 |
|---|---|
| Medicare Enrollment ID | O20050107000849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972782019 | NPI | - | NPPES |
| 216965 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 21696 (South Carolina) | Primary |
| Provider Name | Thaer A Joudeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851355572 PECOS PAC ID: 0345226999 Enrollment ID: I20040625000209 |
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