Provider Demographics
NPI:1437197142
Name:SOUTHSIDE INTERNAL MEDICINE OF FREDERICKSBURG PC
Entity Type:Organization
Organization Name:SOUTHSIDE INTERNAL MEDICINE OF FREDERICKSBURG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-891-5550
Mailing Address - Street 1:4103 LAFAYETTE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4229
Mailing Address - Country:US
Mailing Address - Phone:540-891-5550
Mailing Address - Fax:540-891-5554
Practice Address - Street 1:4103 LAFAYETTE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4229
Practice Address - Country:US
Practice Address - Phone:540-891-5550
Practice Address - Fax:540-891-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty