Look up the most recent NPI and PECOS records

Southside Family Medicine

Family Medicine

Allopathic & Osteopathic Physicians

191 Centre South Blvd, Aiken, SC 29803-6313

PECOS Enrollment

Based on the most recent information from CMS, provider Southside Family Medicine does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1891125845
Provider Type
Organization
Full Name
Southside Family Medicine

Subpart
No
Enumeration Date
11/12/2013
Last Updated
11/12/2013

Contact Information

Practice Location

191 Centre South Blvd, Aiken, SC 29803-6313

(803) 335-1477

(803) 335-1385

Mailing Location

191 Centre South Blvd, Aiken, SC 29803-6313

(803) 335-1477

(803) 335-1385

Authorized Official

Saavedra, Roland I (Owner)

(803) 335-1477

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 25789 South Carolina

Southside Family Medicine

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Moore, Thomas Allen

Schwartz, Alan Christopher

Millwood, Charles Edward

Zimmerman, David Wayne

University Medical Associates Of Aiken Pa

Toomer, Catherine Harmon

Leopoldo M. Muniz, Md, Llc

Umg Prompt Care South Carolina,Llc

Dominguez, David

Manigo-Johnson, Monica