Southside Family Practice

LBN: Southside Family Practice P.C.
Southside Family Practice is an health care organization with primary practice located at 24 S Adams St , Petersburg VA 23803-4525. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Southside Family Practice P.C. can be contacted via phone (804) 733-3739, or through Moten, Shirlene Tolbert via phone (804) 733-3739.

Contact Information

Primary practice address
24 S Adams St Petersburg VA 23803-4525
Phone: (804) 733-3739
Fax: (804) 722-0634
Website:
Map and Directions
Authorized official contact:
Name: Moten, Shirlene Tolbert Doctor of Medicine (MD)
Phone: (804) 733-3739

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101054986 Virginia

Profile Details

NPI number 1780700765
LBN Legal business name Southside Family Practice P.C.
DBA Doing business as Southside Family Practice
Authorized official Moten, Shirlene Tolbert Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 22nd, 2007
Last updated Nov 16th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780700765 NPPES
Virginia MEDICAID 005637686

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