Provider Demographics
NPI:1982460200
Name:NORTHSIDE MEDICAL PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:NORTHSIDE MEDICAL PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-797-0425
Mailing Address - Street 1:1605 NASHVILLE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2132
Mailing Address - Country:US
Mailing Address - Phone:931-540-4210
Mailing Address - Fax:931-380-1202
Practice Address - Street 1:641 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2816
Practice Address - Country:US
Practice Address - Phone:931-540-4210
Practice Address - Fax:931-380-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty