Provider Demographics
NPI:1710056387
Name:SOUTHSIDE COMMUNITY HOSPITAL INC.
Entity type:Organization
Organization Name:SOUTHSIDE COMMUNITY HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-4708
Mailing Address - Street 1:PO BOX 41000
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-4100
Mailing Address - Country:US
Mailing Address - Phone:434-315-5000
Mailing Address - Fax:
Practice Address - Street 1:1705 E. 3RD ST.
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1199
Practice Address - Country:US
Practice Address - Phone:434-315-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA780021OtherANTHEM BCBS
=========OtherTRICARE (HEALTHNET FED)
1520OtherGENTIVA CARECENTRIX
VA59075OtherCARENET(MEDICAID HMO)
VA004970551Medicaid
VA20066OtherOPTIMA FAMILY CARE
=========OtherHUMANA GOLD CHOICE
VA59075OtherCARENET(MEDICAID HMO)