Provider Demographics
NPI:1427038884
Name:SOUTHSIDE PEDIATRICS, INC.
Entity Type:Organization
Organization Name:SOUTHSIDE PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-865-2700
Mailing Address - Street 1:7830 MCFARLAND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4705
Mailing Address - Country:US
Mailing Address - Phone:317-865-2700
Mailing Address - Fax:317-865-2711
Practice Address - Street 1:7830 MCFARLAND LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4705
Practice Address - Country:US
Practice Address - Phone:317-865-2700
Practice Address - Fax:317-865-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50000900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty