| Southside Medical Clinic Inc | |
|
913 South 10th Street Mount Vernon IL 62864-5313 | |
| (618) 242-2745 | |
| (618) 242-2766 |
| Full Name | Southside Medical Clinic Inc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 913 South 10th Street, Mount Vernon, Illinois |
| Authorized Official Name and Position | Bruce Wayne Melvin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6182422745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Clinic Inc 913 South 10th Street Mount Vernon IL 62864-5313 Ph: (618) 242-2745 | Southside Medical Clinic Inc 913 South 10th Street Mount Vernon IL 62864-5313 Ph: (618) 242-2745 |
| NPI Number | 1497823314 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497823314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 001 (Illinois) | Primary |
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