Provider Demographics
NPI:1528119781
Name:SOUTHSIDE ENDOCRINOLOGY LLC
Entity type:Organization
Organization Name:SOUTHSIDE ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SAMUEL HENRY
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-957-0034
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2051
Mailing Address - Country:US
Mailing Address - Phone:205-957-0034
Mailing Address - Fax:205-957-0036
Practice Address - Street 1:1900 CRESTWOOD BLVD
Practice Address - Street 2:STE 201
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2051
Practice Address - Country:US
Practice Address - Phone:205-957-0034
Practice Address - Fax:205-957-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9301207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALL192OtherMEDICARE PTAN