Southside Medical Clinic INC
NPI #1497823314 in Mount Vernon, Illinois
Provider Information
- NPI Number
- 1497823314
- Entity Type
- Organization
- Organization Name
- Southside Medical Clinic INC
- Primary Specialty
- Clinic/Center - Rural Health
- Enumeration Date
- Nov 30, 2006
- Last Updated
- Jul 21, 2022
Practice Location
- Address
- 913 SOUTH 10TH STREET
- City
- Mount Vernon
- State
- Illinois
- ZIP Code
- 62864-5313
- Phone
- (618) 242-2745
Authorized Official
- Name
- BRUCE WAYNE MELVIN
- Title
- EXECUTIVE DIRECTOR
- Phone
- (618) 242-2745
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Rural Health — Rural Health |
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