Provider Demographics
NPI:1861447732
Name:SOUTH HILL FAMILY MEDICINE INCORPORATED
Entity Type:Organization
Organization Name:SOUTH HILL FAMILY MEDICINE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE ASST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-447-6969
Mailing Address - Street 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-2240
Practice Address - Street 1:514 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1906
Practice Address - Country:US
Practice Address - Phone:434-447-6969
Practice Address - Fax:434-447-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007610327Medicaid
VA493833Medicare Oscar/Certification
VA007610327Medicaid