NPIMap

Organization Active NPI

Southside Medical Clinic

  • Internal Medicine Physician
  • Fort Smith, AR
National Provider Identifier
1194937235
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
E1751 Issued in AR
Legal business name
SOUTHSIDE MEDICAL CLINIC
Practice address
623 S 21St St
Fort Smith, AR 72901-3914
Phone
(479) 441-1500
Fax
(479) 441-1502
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thuylinh Pham, MDNPI 1356396790
Title
Ceo
Phone
(870) 424-5079

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X E1751 AR Primary

Addresses

Primary practice location

623 S 21St St
Fort Smith, AR 72901-3914

Mailing address

PO Box 310
Mountain Home, AR 72654-0310
Phone (870) 424-0899

National Provider Directory

National Provider Directory
Tax ID family
Southside Medical Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194937235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540310",
            "telephone_number": "870-424-0899",
            "fax_number": "870-424-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 S 21ST ST",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729013914",
            "telephone_number": "479-441-1500",
            "fax_number": "479-441-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "THUYLINH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-424-5079",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E1751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.