Southside Medical Group PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

R77046 Issued in MO

Legal business name

SOUTHSIDE MEDICAL GROUP PC

Practice address

9700 Mackenzie Rd Ste 105
Saint Louis, MO 63123-5423

Phone

(314) 638-9100

NPI assigned

Jun 11, 2007

Organization subpart

No

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

Authorized official

Name

Subodh K Mehra, M.D.

Title

Doctor

Phone

(314) 638-9100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1912101486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9700 MACKENZIE RD STE 105",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631235423",
            "telephone_number": "314-638-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9700 MACKENZIE RD STE 105",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631235423",
            "telephone_number": "314-638-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "MEHRA",
        "authorized_official_first_name": "SUBODH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "314-638-9100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "R77046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; 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.