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Contact Information

SOUTHSIDE PEDIATRICS, P.C.
502 BEECH ST
FARMVILLE, VA23901-1222
 Phone: 434-392-9438
 Fax: 434-392-7630
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Legal Medicine

173000000X
Indicates primary specialty

NPI Profile & details for SOUTHSIDE PEDIATRICS PC · (Female)

NPI Number 1366525040
Status Active
Credentials
Entity Individual
Enumeration date 10/24/2006
Last updated 06/09/2022 - About 4 years ago
Sole proprietor 1 Not specified
Identifiers
  • VA License # 0101035421
  • VA Medicaid 006702767
  • VA Medicaid 010018579
  • VA Other 081150 DR D ANTHEM#
  • VA Other 99161 OPTIMA # DR D
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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