SOUTHSIDE PHYSICIAN NETWORK LLC NPI 1811146194

NPI Information

NPI: 1811146194
Provider Name: SOUTHSIDE PHYSICIAN NETWORK LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
CLIA Number: 49D2149873
Address: 436 CLAIRMONT CT
SUITE 105
COLONIAL HEIGHTS, VA
ZIP 23834
Phone: (804) 765-5473

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NPI Details

SOUTHSIDE PHYSICIAN NETWORK LLC is an internal medicine in Colonial Heights, VA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SOUTHSIDE PHYSICIAN NETWORK LLC NPI is 1811146194. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

436 CLAIRMONT CT
SUITE 105
COLONIAL HEIGHTS, VA
ZIP 23834
Phone: (804) 765-5473
Fax: (804) 765-6490

The provider's authorized official is Joanne Austin .
The authorized official title is Director and has the following contact phone number (804) 765-5473.

The CLIA number assigned to this NPI record is 49D2149873 - other - free standing ed lab with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 9/11/2008 and was last updated on 11/15/2018.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	207Q00000X	Family Medicine			No
2	207V00000X	Obstetrics & Gynecology			No
3	207X00000X	Orthopaedic Surgery			No
4	207Y00000X	Otolaryngology			No
5	207RC0000X	Internal Medicine	Cardiovascular Disease	VIRGINIA	No
6	208600000X	Surgery		VIRGINIA	No
7	2086S0129X	Surgery	Vascular Surgery		No
8	208800000X	Urology			No
9	208D00000X	General Practice			No
10	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)			No
11	231H00000X	Audiologist		VIRGINIA	No
12	207R00000X	Internal Medicine			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1811146194	MEDICAID	VIRGINIA

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: 11/21/2025

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