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SOUTHSIDE COMMUNITY HEALTH SERVICES INC. NPI 1679690952


NPI Information

NPI: 1679690952
Provider Name: SOUTHSIDE COMMUNITY HEALTH SERVICES, INC.

Other Name: SOUTHSIDE VISION CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
4243 4TH AVE S
MINNEAPOLIS, MN
ZIP 55409
Phone: (612) 822-9030
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SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. is a family medicine in Minneapolis, MN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. NPI is 1679690952. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Southside Vision Clinic.

The provider's business location address is:

4243 4TH AVE S
MINNEAPOLIS, MN
ZIP 55409-113
Phone: (612) 822-9030
Fax: (612) 821-2818

The provider's authorized official is William Henry Tendle .
The authorized official title is Executive Director-ceo and has the following contact phone number (612) 821-2800.

The enumeration date for this NPI number is 3/23/2007 and was last updated on 4/30/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1241815MEDICARE OSCAR/CERTIFICATIONMINNESOTA
2C00626MEDICARE PINMINNESOTA
3515753600MEDICAIDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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