NPIMap

Organization Active NPI

Southside Urology Clinic PC

  • Urology Physician
  • Farmville, VA
National Provider Identifier
1093938490
Registry record updated Jan 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
0101037122 Issued in VA
Legal business name
SOUTHSIDE UROLOGY CLINIC PC
Practice address
800 Oak St
Farmville, VA 23901-1199
Phone
(434) 392-9449
Fax
(434) 392-5530
NPI assigned
Apr 11, 2007
Last updated
Jan 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles D Taylor, MDNPI 1528066297
Title
Owner /President
Phone
(434) 392-9449

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 0101037122 VA Primary

Addresses

Primary practice location

800 Oak St
Farmville, VA 23901-1199

Mailing address

PO Box 347
Farmville, VA 23901-0347
Phone (434) 392-9449

Other identifiers 4

IdentifierTypeStateIssuer
1528066297OtherPHYSICIAN NPI
1528066297MedicaidVA
CM5051OtherRAILROAD MEDICARE GROUP #
340001025OtherRAILROAD MEDICARE PIN

Other names 1

  • The Southside Urology Clinic, PC Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1093938490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 347",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239010347",
            "telephone_number": "434-392-9449",
            "fax_number": "434-392-5530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OAK ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239011199",
            "telephone_number": "434-392-9449",
            "fax_number": "434-392-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE UROLOGY CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER /PRESIDENT",
        "authorized_official_telephone_number": "434-392-9449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101037122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN NPI",
            "identifier": "1528066297",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528066297",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CM5051",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "340001025",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Southside Urology Clinic, PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Farmville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.