| Southside Family Clinic Llc | |
|
506 W Highway 14 Delcambre LA 70528-2308 | |
| (337) 685-2020 | |
| Not Available |
| Full Name | Southside Family Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 506 W Highway 14, Delcambre, Louisiana |
| Authorized Official Name and Position | John Dies (PRESIDENT) |
| Authorized Official Contact | 3375804061 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Family Clinic Llc 506 W Highway 14 Delcambre LA 70528-2308 Ph: () - | Southside Family Clinic Llc 506 W Highway 14 Delcambre LA 70528-2308 Ph: (337) 685-2020 |
| NPI Number | 1073109930 |
|---|---|
| Provider Enumeration Date | 12/15/2020 |
| Last Update Date | 03/14/2022 |
| Medicare PECOS PAC ID | 3779859392 |
|---|---|
| Medicare Enrollment ID | O20210624002988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073109930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |