Southside Family Physicians, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHSIDE FAMILY PHYSICIANS, INC

Practice address

8523 Madison Ave
Suite a
Indianapolis, IN 46227-6115

Phone

(317) 888-2811

Fax

(317) 888-2822

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Robin Ann Maluck

Title

Office Manager

Phone

(317) 888-2811

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1912060153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8523 MADISON AVE",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276115",
            "telephone_number": "317-888-2811",
            "fax_number": "317-888-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8523 MADISON AVE",
            "address_2": "SUITE A",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276115",
            "telephone_number": "317-888-2811",
            "fax_number": "317-888-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE FAMILY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "MALUCK",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "317-888-2811",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100057680A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southport Dental, P.C.
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• Southside Emergency Associates
• Southside Eye Associates
• Southside Family Medical Group, LLC
• Southside Internal Medicine PC
• Southside OB-GYN PC
• Southside Pediatrics, Inc.
• Southside Physical Therapy Clinic
• Southside Youth Council

• Family Medicine Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; 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.