SOUTHSIDE MEDICAL CLINIC (NPI# 1356681845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356681845 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE MEDICAL CLINIC |
| Practice Address |
1707 E Edgewood Dr Lakeland FL 33803-3470 |
| Practice Telephone | 8636889219 |
| Practice Fax Number | 8636874863 |
| Mailing Telephone | 8636889219 |
| Mailing Fax Number | 8636874863 |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-02-21 |
| Authorized Official Name | DR. ROGER DAVID SUARES (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8636889219 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | ME0043239 | FL | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194937235 | Southside Medical Clinic | Internal Medicine | 623 S 21st St, Fort Smith, AR 72901-3914 | 2007-05-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTHSIDE MEDICAL CLINIC | 714 W Hamilton Ave, Eau Claire, WI 54701-6937 |
| Street Address |
1707 E EDGEWOOD DR |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803-3470 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376643262 | Roger David Suares | Family Medicine | 1707 E Edgewood Dr, Lakeland, FL 33803-3470 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295392785 | Occupational Health Centers of The Southwest, P.a. | Clinic/Center | 4440 Old Tampa Hwy, Lakeland, FL 33811-1135 | 2019-05-21 |
| 1083185151 | Ancient Art of Healing | Clinic/Center | 6700 S Florida Ave Ste 5, Lakeland, FL 33813-3310 | 2018-12-16 |
| 1851898613 | Lakeland Medical Massage LLC | Clinic/Center | 215 Imperial Blvd Ste B1, Lakeland, FL 33803-4689 | 2018-04-09 |
| 1609301308 | Path Medical, LLC | Clinic/Center | 809 S Florida Ave, Lakeland, FL 33801-5234 | 2017-05-01 |
| 1104379304 | Core Training Services LLC | Clinic/Center | 527 Poppell Dr, Lakeland, FL 33813-1139 | 2016-07-25 |
| 1760627905 | Applied Behavioral Learning Experiences, Inc | Clinic/Center | 145 E Edgewood Dr, Lakeland, FL 33803-4014 | 2008-12-02 |
| 1346439569 | Watson Clinic LLP | Clinic/Center | 1550 Lakeland Hills Blvd, Lakeland, FL 33805-3204 | 2007-10-24 |
| 1417422015 | Capernaum Medical Center for Kids Pllc | Clinic/Center | 5129 S Lakeland Dr Ste 2, Lakeland, FL 33813-2599 | 2018-10-10 |
| 1437650579 | Palm Medical Center Lakeland, LLC | Clinic/Center | 135 E 1st St, Lakeland, FL 33805-4609 | 2018-02-23 |
| 1285140392 | Slim Body Design, LLC | Clinic/Center | 5030 Kingswood Dr, Lakeland, FL 33813-3026 | 2017-12-27 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.