Southside Community Services Board – Community/Behavioral Health Agency, NPI 1700890761
Community/Behavioral Health Agency
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Southside Community Services Board
2087 Lawrenceville Plank Road
Lawrenceville, VA 23868
Phone: (434) 848-4121
Fax: (434) 848-4148
Type: Location
523 Madison Street
Boydton, VA 23917
Phone: (434) 738-0154
Fax: (434) 738-9545
Type: Location
1478, Trainer Road, Sycamore Hill, Clarksville, Montgomery County, Tennessee, 37042, United States
143 INDUSTRIAL PARKWAY
CLARKSVILLE, VA 23927
Phone: (434) 572-6916
Fax: (434) 374-3321
Type: Mailing
143 INDUSTRIAL PARKWAY
CLARKSVILLE, VA 23927
Phone: (434) 572-6916
Fax: (434) 374-3321
Type: Location
424, Hamilton Boulevard, South Boston, Halifax County, Virginia, 24592, United States
SOUTH BOSTON, VA 24592
Phone: (434) 572-6916
Fax: (434) 572-4881
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-07-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (254 days ago).
Enrollment records
1
Earliest due date
2025-09-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050708000612 | O | Clinic/Group Practice | VA | 2025-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 23868)
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