Southside Internal Medicine, PC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

0101048599 Issued in VA

Legal business name

SOUTHSIDE INTERNAL MEDICINE, PC

Practice address

202 Agee Street
Farmville, VA 23901

Phone

(434) 392-6143

Fax

(434) 392-3866

NPI assigned

Oct 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Luke San, M.D.

Title

M.D.

Phone

(434) 392-6143

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263859200000",
    "number": "1609065341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 AGEE STREET",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "23901",
            "telephone_number": "434-392-6143",
            "fax_number": "434-392-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 AGEE STREET",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "23901",
            "telephone_number": "434-392-6143",
            "fax_number": "434-392-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE INTERNAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2010-01-19",
        "status": "A",
        "authorized_official_last_name": "SAN",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "434-392-6143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "VA",
            "license": "0101048599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005849632",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southside Community Hospital Inc.
• Southside Community Hospital, Inc.
• Southside Community Hospital, Inc.
• Southside Community Hospital, Inc.
• Southside Eye Center PC
• Southside Medical Practice PLLC
• Southside Optical Center LLC
• Southside Orthopedic Associates, PC
• Southside Therapy Associates, Inc.
• Southside Urology Clinic PC

• Health Maintenance Organization in Farmville, VA
• Providers in Farmville, VA by specialty
• Health Maintenance Organization in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; 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.