NPIMap

Organization Active NPI

Southside Family Practice P.C.

  • Family Medicine Physician
  • Petersburg, VA
National Provider Identifier
1780700765
Registry record updated Nov 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101054986 Issued in VA
Legal business name
SOUTHSIDE FAMILY PRACTICE P.C.
Practice address
24 S Adams St
Petersburg, VA 23803-4525
Phone
(804) 733-3739
Fax
(804) 722-0634
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2008

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

Authorized official

Name
Dr. Shirlene Tolbert Moten, M.D.NPI 1235271040
Title
Medical Director
Phone
(804) 733-3739

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 0101054986 VA Primary

Addresses

Primary practice location

24 S Adams St
Petersburg, VA 23803-4525

Mailing address

24 S Adams St
Petersburg, VA 23803-4525
Phone (804) 733-3739

Other identifiers 1

IdentifierTypeStateIssuer
005637686MedicaidVA

Other names 1

  • southside family practice Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226793600000",
    "number": "1780700765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 S ADAMS ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034525",
            "telephone_number": "804-733-3739",
            "fax_number": "804-722-0634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S ADAMS ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034525",
            "telephone_number": "804-733-3739",
            "fax_number": "804-722-0634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY PRACTICE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2008-11-16",
        "status": "A",
        "authorized_official_last_name": "MOTEN",
        "authorized_official_first_name": "SHIRLENE",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "804-733-3739",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101054986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005637686",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "southside family practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Petersburg, VA

Sources for this page

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