Basic Information
| Provider Information | |||||||||
| NPI: | 1740479674 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED NEIGHBORHOOD HEALTH SERVICES, INC | ||||||||
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| OtherOrganizationName: | SOUTHSIDE FAMILY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2711 FOSTER AVENUE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372105307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152273000 | ||||||||
| FaxNumber: | 6155155773 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 CHARLES E DAVIS BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157261807 | ||||||||
| FaxNumber: | 6157121061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2007 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | HAILE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6152273000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 3818145 | 05 | TN | MEDICAID |