SOUTH SIDE CONVENIENT CARE INC (NPI# 1679007249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679007249 |
| Entity Type | Organization |
| Organization Name | SOUTH SIDE CONVENIENT CARE INC |
| Practice Address |
4115 Harrison St Bellevue NE 68147-1059 |
| Practice Telephone | 4029320692 |
| Practice Fax Number | 4026146731 |
| Mailing Telephone | 4029320692 |
| Mailing Fax Number | 4026146731 |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MRS. SAMANTHA SENANAYAKA (CLINIC CREDENTIALING CONTACT) |
| Authorized Official Telephone | 4023507616 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10026666300 | 05 |
| Street Address |
4115 HARRISON ST |
| City | BELLEVUE |
| State | NE |
| Zip Code | 68147-1059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912241506 | Samantha Senanayaka | Physician Assistant | 4115 Harrison St, Bellevue, NE 68147-1059 | 2012-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568970259 | Misty A Gasa | Clinic/Center | 7155 S 41st Ter, Bellevue, NE 68147-1056 | 2018-01-16 |
| 1720029994 | Michelle L Armstrong | Chiropractor | 4105 Harrison St, Bellevue, NE 68147-1059 | 2006-06-09 |
| 1093810921 | Christoph P. Foix | Dentist | 4028 Harrison Plz, Bellevue, NE 68147-1090 | 2006-09-14 |
| 1720211592 | Chris Foix Dds PC | Dentist | 4028 Harrison Plz, Omaha, NE 68147-1090 | 2009-08-27 |
| 1861562522 | Marvin B Dvorak | Dentist | 4028 Harrison Plz, Omaha, NE 68147-1090 | 2006-11-09 |
| 1497298269 | Dakila Marcelino | Speech-Language Pathologist | 3705 Chandler Rd W, Bellevue, NE 68147-1123 | 2016-11-29 |
| 1548743602 | Debra Fahrer | Registered Nurse | 3705 Chandler Rd W, Bellevue, NE 68147-1123 | 2018-09-13 |
| 1386293116 | Ronald Sebastiano Nocita | Counselor | 3813 Harrison St, Bellevue, NE 68147-1145 | 2019-09-04 |
| 1225180243 | Rami S Shinnawie | Dentist | 3843 Harrison St, Omaha, NE 68147-1145 | 2007-01-18 |
| 1255346292 | Walgreen Co | Pharmacy | 6905 S 36th St, Bellevue, NE 68147-1231 | 2006-07-29 |
| Find all providers in zip 68147 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538557442 | Mariam Abdelghany I | Physician Assistant | 2500 Bellevue Medical Center Drive, Bellevue, NE 68123 | 2014-12-30 |
| 1174899017 | Amber Tario Gudas | Physician Assistant | 1414 116th Ave Ne Ste E, Bellevue, WA 98004-3801 | 2012-03-26 |
| 1003103565 | Stefany Jeneifer Cameron | Physician Assistant | 1750 112th Ave Ne Ste D050, Bellevue, WA 98004 | 2011-07-06 |
| 1770746505 | Erik H Suh Md Ps | Physician Assistant | 2100 116th Ave Ne, Bellevue, WA 98004 | 2008-07-02 |
| 1700099736 | Michelle M Berlin | Physician Assistant | 2206 Longo Dr Ste 107, Bellevue, NE 68005-2977 | 2007-05-07 |
| 1164569315 | Kristeen Lee Budreau | Physician Assistant | 6639 161st Ave Se, Unit B, Bellevue, WA 98006-5687 | 2007-01-30 |
| 1013012491 | Joseph A. Stangl | Physician Assistant | 3802 Raynor Pkwy, Bellevue, NE 68123-6048 | 2006-09-13 |
| 1528088952 | Patricia L Lightfoot | Physician Assistant | 1135 116th Ave Ne Ste 560, Bellevue, WA 98004-4631 | 2006-07-20 |
| 1831176395 | Anthony Aaron Meador | Physician Assistant | 15585 Ne 24th St, Bellevue, WA 98007-3836 | 2005-12-27 |
| 1255338166 | Earl R Thompson | Physician Assistant | 3308 Samson Way, Bellevue, NE 68123-3234 | 2005-07-07 |
| Find all providers in BELLEVUE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.