Southside Senior Care LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1349 Issued in NC

Legal business name

SOUTHSIDE SENIOR CARE LLC

Practice address

2306 Knob Creek Rd
Johnson City, TN 37604-2366

Phone

(423) 943-3079

NPI assigned

Apr 2, 2008

Organization subpart

No

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

Authorized official

Name

Samuel E Cox, OD

Title

Owner

Phone

(423) 929-2020

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1497927115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366",
            "telephone_number": "423-943-3079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE SENIOR CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-929-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.