NPIMap

Organization Active NPI

Southern Cities Community Clinic

  • Dentist
  • Faribault, MN
National Provider Identifier
1730630393
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SOUTHERN CITIES COMMUNITY CLINIC
Practice address
400 4TH St NW
Faribault, MN 55021-5031
Phone
(507) 384-6830
NPI assigned
Oct 19, 2016
Last updated
Sep 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Authorized official

Name
Nancy Kaiser
Title
Reimbursement Specialist
Phone
(651) 431-3710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

400 4TH St NW
Faribault, MN 55021-5031

Mailing address

PO Box 64979
Saint Paul, MN 55164-0979
Phone (651) 431-5884

National Provider Directory

National Provider Directory
Tax ID family
Southern Cities Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 4th St NW
Faribault, MN 55021
Phone (507) 384-6830

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567555200000",
    "number": "1730630393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64979",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551640979",
            "telephone_number": "651-431-5884",
            "fax_number": "651-431-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 4TH ST NW",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215031",
            "telephone_number": "507-384-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CITIES COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2019-09-04",
        "status": "A",
        "authorized_official_last_name": "KAISER",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "REIMBURSEMENT SPECIALIST",
        "authorized_official_telephone_number": "651-431-3710"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.