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SOUTHSIDE OB/GYN P.C. NPI 1285909002


NPI Information

NPI: 1285909002
Provider Name: SOUTHSIDE OB/GYN P.C.
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 15D0682511

Address:
1205 HADLEY RD
MOORESVILLE, IN
ZIP 46158
Phone: (317) 584-3454
Get Directions

SOUTHSIDE OB/GYN P.C. is an obstetrics gynecology in Mooresville, IN. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. SOUTHSIDE OB/GYN P.C. NPI is 1285909002. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1205 HADLEY RD
MOORESVILLE, IN
ZIP 46158-737
Phone: (317) 584-3454
Fax: (317) 584-3435

The provider's authorized official is Jocelyn Forehand .
The authorized official title is Ceo and has the following contact phone number (317) 865-3600.

The CLIA number assigned to this NPI record is 15D0682511 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/12/2012 and was last updated on 12/14/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology02001767AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========OTHERINDIANATIN
2100047770MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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