1285617613 NPI number — MRS. LEEANN SALOT WEBSTER MD

Table of content: MRS. LEEANN SALOT WEBSTER MD (NPI 1285617613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285617613 NPI number — MRS. LEEANN SALOT WEBSTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALOT WEBSTER
Provider First Name:
LEEANN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALOT
Provider Other First Name:
LEE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285617613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1266 E SHERMAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-739-9009
Provider Business Mailing Address Fax Number:
231-733-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1266 EAST SHERMAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-739-9009
Provider Business Practice Location Address Fax Number:
231-733-0566
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  4301057650 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3289843 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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