Provider Demographics
NPI:1861929523
Name:SOUTHSIDE UNITED HEALTH CENTERS
Entity type:Organization
Organization Name:SOUTHSIDE UNITED HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:336-955-1379
Mailing Address - Street 1:3009 WAUGHTOWN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1634
Mailing Address - Country:US
Mailing Address - Phone:336-293-8728
Mailing Address - Fax:336-293-8733
Practice Address - Street 1:3009 WAUGHTOWN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107
Practice Address - Country:US
Practice Address - Phone:336-293-8728
Practice Address - Fax:336-293-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty