Southside Medical Center PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

21696 Issued in SC

Legal business name

SOUTHSIDE MEDICAL CENTER PA

Practice address

3921 S Highway 14 Ste a
Greenville, SC 29615-6138

Phone

(864) 288-2006

Fax

(864) 288-1678

NPI assigned

Oct 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thaer Joudeh, MDNPI 1851355572

Title

Owner

Phone

(864) 288-2006

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

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

• Thaer A Joudeh, MD

  • Internal Medicine Physician
  • Greenville, SC
  • NPI 1851355572
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1972782019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 S HIGHWAY 14 STE A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156138",
            "telephone_number": "864-288-2006",
            "fax_number": "864-288-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 S HIGHWAY 14 STE A",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296156138",
            "telephone_number": "864-288-2006",
            "fax_number": "864-288-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "JOUDEH",
        "authorized_official_first_name": "THAER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-288-2006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "21696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "216965",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.