South Side Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

207Q00000X Issued in PA

Legal business name

SOUTH SIDE CLINIC

Practice address

1831 Pittston Ave
Scranton, PA 18505-1651

Phone

(570) 507-9517

NPI assigned

Apr 25, 2016

Last updated

Apr 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathryn Skiles

Title

Billing

Phone

(570) 507-9517

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1461542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1659726875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 PITTSTON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185051651",
            "telephone_number": "570-507-9517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 PITTSTON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185051651",
            "telephone_number": "570-507-9517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SIDE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-25",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "SKILES",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "570-507-9517"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "207Q00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Scranton, PA
• Providers in Scranton, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; 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.