NPIMap

Organization Active NPI

Kidmed Southside PLC

  • Urgent Care Clinic/Center
  • Midlothian, VA
National Provider Identifier
1477869337
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
KIDMED SOUTHSIDE PLC
Practice address
5021 Craig Rath Blvd
BLDG IV
Midlothian, VA 23112-6243
Phone
(804) 422-5437
Fax
(804) 422-5438
NPI assigned
Aug 28, 2010
Last updated
Aug 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KIDMED INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Authorized official

Name
Dr. Mark Adam Flanzenbaum, M.D.NPI 1134129398
Title
President/Managing Partner
Phone
(804) 592-5437

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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

5021 Craig Rath Blvd
BLDG IV
Midlothian, VA 23112-6243

Mailing address

4687 Pouncey Tract Rd
Glen Allen, VA 23059-5802
Phone (804) 422-5437

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2015652Kidmed Southside5021 Craig Rath Boulevard Building - IV, Midlothian, VA 23112ComplianceAug 30, 2027

National Provider Directory

National Provider Directory
Part of
Kidmed Inc

Locations

5021 Craig Rath Blvd
Bldg Iv
Midlothian, VA 23112
Phone (804) 422-5437

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1282953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1477869337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4687 POUNCEY TRACT RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230595802",
            "telephone_number": "804-422-5437",
            "fax_number": "804-422-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5021 CRAIG RATH BLVD",
            "address_2": "BLDG IV",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231126243",
            "telephone_number": "804-422-5437",
            "fax_number": "804-422-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDMED SOUTHSIDE PLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIDMED INC",
        "enumeration_date": "2010-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "FLANZENBAUM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT/MANAGING PARTNER",
        "authorized_official_telephone_number": "804-592-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.