Southside Wellness Center Inc

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

License

261705602 Issued in MO

Legal business name

SOUTHSIDE WELLNESS CENTER INC

Practice address

3017 Park Ave
Saint Louis, MO 63104-1433

Phone

(314) 664-5024

NPI assigned

Dec 12, 2007

Organization subpart

No

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

Authorized official

Name

Mary Parram

Title

Assistant Director

Phone

(314) 664-5024

Specialties & licenses 5

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210896000000",
    "number": "1649453796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3017 PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041433",
            "telephone_number": "314-664-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3017 PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041433",
            "telephone_number": "314-664-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2008-05-16",
        "status": "A",
        "authorized_official_last_name": "PARRAM",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ASSISTANT  DIRECTOR",
        "authorized_official_telephone_number": "314-664-5024"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "MO",
            "license": "291705606",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MO",
            "license": "851705608",
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chore Provider",
            "state": "MO",
            "license": "281705608",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": "MO",
            "license": "261705602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "0000466",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291705606",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261705602",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281705608",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "851705608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Personal Care Attendant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Personal Care Attendant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.