Provider Demographics
NPI:1508154048
Name:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Entity type:Organization
Organization Name:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
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:434-200-4798
Mailing Address - Street 1:PO BOX 41000
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-4100
Mailing Address - Country:US
Mailing Address - Phone:434-315-5000
Mailing Address - Fax:
Practice Address - Street 1:1705 E. 3RD ST.
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-315-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHSIDE COMMUNITY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based