1154334811 NPI number — SALEM MEDICAL PROFESSIONALS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154334811 NPI number — SALEM MEDICAL PROFESSIONALS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALEM MEDICAL PROFESSIONALS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154334811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 504290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63150-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-935-3285
Provider Business Mailing Address Fax Number:
856-935-4382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 BY PASS RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08079-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-935-3285
Provider Business Practice Location Address Fax Number:
856-935-4382
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOME
Authorized Official First Name:
GARY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESDIENT
Authorized Official Telephone Number:
616-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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