| NPI | 1043331812 |
|---|---|
| Doing Business As | SOUTHSIDE MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | PAMELA E THOMSON Credentialing Manager 817-744-7524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2023-09-18 |