Southside Medical Center Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SOUTHSIDE MEDICAL CENTER INC

Practice address

5525 S Martin Luther King Jr Blvd
Lansing, MI 48911-3546

Phone

(517) 913-3888

NPI assigned

Nov 10, 2014

Organization subpart

No

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

Authorized official

Name

Douglas Vanderjact, DO

Title

Owner

Phone

(517) 913-3888

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1245636885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 S MARTIN LUTHER KING JR BLVD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489113546",
            "telephone_number": "517-913-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 S MARTIN LUTHER KING JR BLVD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489113546",
            "telephone_number": "517-913-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-10",
        "last_updated": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "VANDERJACT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-913-3888",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1730121880",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cory Soulliere
• Soumya Madala MD PLLC
• Sound Mind Counseling Services LLC
• Fadi Souri
• South Cedar Osteopathic Services, P.C.
• Christopher N Sovey, PT, DPT, RN, BSN
• Danielle Nicole Sovey, NP-BC
• Anthony Mark Spagnuolo, D.D.S., M.S.D.
• Julia E Spalding, MD
• Danielle Marie Spannagel, M.A. CCC-SLP

• Internal Medicine Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; 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.