NPIMap

Organization Active NPI

Southside United Health Centers

  • Clinical Social Worker
  • Winston Salem, NC
National Provider Identifier
1861929523
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SOUTHSIDE UNITED HEALTH CENTERS
Practice address
3009 Waughtown St
Winston Salem, NC 27107
Phone
(336) 293-8728
Fax
(336) 293-8733
NPI assigned
May 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Shirley Kotofsky, CPC
Title
Financial Services Representative
Phone
(336) 955-1379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

3009 Waughtown St
Winston Salem, NC 27107

Mailing address

3009 Waughtown St
Winston Salem, NC 27107-1634
Phone (336) 293-8728

National Provider Directory

National Provider Directory
Tax ID family
Southside United Health Centers6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1861929523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 WAUGHTOWN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271071634",
            "telephone_number": "336-293-8728",
            "fax_number": "336-293-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3009 WAUGHTOWN ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27107",
            "telephone_number": "336-293-8728",
            "fax_number": "336-293-8733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE UNITED HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-12",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "KOTOFSKY",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "FINANCIAL SERVICES REPRESENTATIVE",
        "authorized_official_telephone_number": "336-955-1379",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; 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.