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SOUTHSIDE MEDICAL CLINIC
NPI 1194937235
Internal Medicine in Fort Smith, AR

Active since May 03, 2007CLIA 04D1071452 · Waiver
623 S 21ST ST, FORT SMITH, AR 72901(479) 441-1500(479) 441-1502 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southside Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHSIDE MEDICAL CLINIC (NPI 1194937235) is a healthcare organization registered as an internal medicine in Fort Smith, Arkansas and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through July 25, 2027 and lists Thuylinh Pham, Ceo, as its authorized official.

NPPES Registry Identity

NPI1194937235
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTHSIDE MEDICAL CLINIC
Location Address623 S 21ST STFort Smith, AR 72901-3914
Mailing AddressPo Box 310Mountain Home, AR 72654-0310 · (870) 424-0899 · Fax (870) 424-8455
Phone(479) 441-1500
Fax(479) 441-1502
Organization SubpartNo
Authorized OfficialThuylinh PhamCeo · (870) 424-5079
Enumeration DateMay 3, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1194937235 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in AR · E1751
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
623 S 21ST ST, Fort Smith, AR 72901
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 04D1071452

Southside Medical Clinic · Fort Smith, AR
Active · expires Jul 25, 2027
CLIA Number04D1071452
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorThuylinh H. Pham
Laboratory Phone(479) 441-1500
Laboratory LocationSouthside Medical Clinic623 South 21st Street, Fort Smith, AR 72901
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THUYLINH HO PHAM MD PLLC
Internal Medicine
623 S 21ST ST
FORT SMITH, AR 72901
Sebastian County (479) 441-1500
HASSAN M MASRI M.D.
Internal Medicine (Gastroenterology)
623 S 21ST ST
FORT SMITH, AR 72901
Sebastian County (479) 441-1502
THUYLINH PHAM M.D.
Internal Medicine
623 S 21ST ST
FORT SMITH, AR 72901
Sebastian County (479) 441-1500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southside Medical Clinic's NPI number?

The NPI number for Southside Medical Clinic is 1194937235. It was assigned to this organization in the NPPES registry on May 3, 2007.

Where is Southside Medical Clinic located?

Southside Medical Clinic is located at 623 S 21st St, Fort Smith, AR 72901. The listed phone number is (479) 441-1500.

What is Southside Medical Clinic's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Southside Medical Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D1071452) is associated with this NPI, valid through July 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southside Medical Clinic was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.