| Southside Pediatrics & Adult Care Llc | |
|
1185 Mount Aetna Rd Ste 200 Hagerstown MD 21740-6832 | |
| (240) 513-6300 | |
| Not Available |
| Full Name | Southside Pediatrics & Adult Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1185 Mount Aetna Rd Ste 200, Hagerstown, Maryland |
| Authorized Official Name and Position | Christa Martin (OWNER) |
| Authorized Official Contact | 2405136300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Pediatrics & Adult Care Llc 1185 Mount Aetna Rd Ste 200 Hagerstown MD 21740-6832 Ph: (240) 513-6300 | Southside Pediatrics & Adult Care Llc 1185 Mount Aetna Rd Ste 200 Hagerstown MD 21740-6832 Ph: (240) 513-6300 |
| NPI Number | 1669970067 |
|---|---|
| Provider Enumeration Date | 01/31/2018 |
| Last Update Date | 06/09/2022 |
| Medicare PECOS PAC ID | 4587915459 |
|---|---|
| Medicare Enrollment ID | O20180918000071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669970067 | NPI | - | NPPES |
| 1053302455 | Other | MD | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 193525 (Maryland) | Primary |
| Provider Name | Susan E Mcvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093711970 PECOS PAC ID: 0446146187 Enrollment ID: I20040227000492 |
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