| Southside Medical Center Pa | |
|
1925a Oleander Dr Wilmington NC 28403-2334 | |
| (910) 251-7715 | |
| (910) 763-7845 |
| Full Name | Southside Medical Center Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1925a Oleander Dr, Wilmington, North Carolina |
| Authorized Official Name and Position | James Henry Pridgen (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9102517715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Center Pa 1925a Oleander Dr Wilmington NC 28403-2334 Ph: (910) 251-7715 | Southside Medical Center Pa 1925a Oleander Dr Wilmington NC 28403-2334 Ph: (910) 251-7715 |
| NPI Number | 1003099409 |
|---|---|
| Provider Enumeration Date | 12/10/2007 |
| Last Update Date | 05/17/2012 |
| Medicare PECOS PAC ID | 6305927690 |
|---|---|
| Medicare Enrollment ID | O20080111000667 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003099409 | NPI | - | NPPES |
| 89012R9 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 29495 (North Carolina) | Primary |
| Provider Name | James H Pridgen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215083563 PECOS PAC ID: 9032014154 Enrollment ID: I20041006000438 |
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