Provider Demographics
NPI:1710056387
Name:SOUTHSIDE COMMUNITY HOSPITAL INC.
Entity Type:Organization
Organization Name:SOUTHSIDE COMMUNITY HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-4708
Mailing Address - Street 1:800 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1199
Mailing Address - Country:US
Mailing Address - Phone:434-315-2550
Mailing Address - Fax:434-315-2551
Practice Address - Street 1:711 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1119
Practice Address - Country:US
Practice Address - Phone:434-315-2550
Practice Address - Fax:434-315-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004970551Medicaid
VA20066OtherOPTIMA FAMILY CARE
VA59075OtherCARENET(MEDICAID HMO)
VA780021OtherANTHEM BCBS
1520OtherGENTIVA CARECENTRIX
VA004970551Medicaid
VA20066OtherOPTIMA FAMILY CARE
VA59075OtherCARENET(MEDICAID HMO)