NPIMap

Organization Active NPI

Southside United Health Centers

  • Dentist
  • Winston Salem, NC
National Provider Identifier
1265911705
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTHSIDE UNITED HEALTH CENTERS
Practice address
2101 Peters Creek Pkwy
Winston Salem, NC 27127
Phone
(336) 955-1379
Fax
(336) 893-9987
NPI assigned
Aug 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Authorized official

Name
Cre'Shawna White
Title
Finance Director
Phone
(336) 529-2163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X NC Primary

Addresses

Primary practice location

2101 Peters Creek Pkwy
Winston Salem, NC 27127

Mailing address

PO Box 12341
Winston Salem, NC 27117-2341
Phone (336) 955-1379

National Provider Directory

National Provider Directory
Tax ID family
Southside United Health Centers6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1533600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1265911705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12341",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271172341",
            "telephone_number": "336-955-1379",
            "fax_number": "336-893-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 PETERS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27127",
            "telephone_number": "336-955-1379",
            "fax_number": "336-893-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE UNITED HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-07",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CRE'SHAWNA",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "336-529-2163"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.