| Southside Medical Practice Pllc | |
|
502 Beech St Farmville VA 23901-1222 | |
| (434) 392-9438 | |
| (434) 392-7630 |
| Full Name | Southside Medical Practice Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 502 Beech St, Farmville, Virginia |
| Authorized Official Name and Position | Tammy Atkins (PRACTICE MANAGER) |
| Authorized Official Contact | 4343929438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Practice Pllc 502 Beech St Farmville VA 23901-1222 Ph: (434) 392-9438 | Southside Medical Practice Pllc 502 Beech St Farmville VA 23901-1222 Ph: (434) 392-9438 |
| NPI Number | 1073177978 |
|---|---|
| Provider Enumeration Date | 04/25/2019 |
| Last Update Date | 07/13/2022 |
| Medicare PECOS PAC ID | 7719210699 |
|---|---|
| Medicare Enrollment ID | O20190620002854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073177978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Victor Romeo Clemente Adaniel |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1457665846 PECOS PAC ID: 2668651977 Enrollment ID: I20190624003483 |
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