1780856559 NPI number — MARTIN E. SALM, M.D., LTD

Table of content: (NPI 1780856559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780856559 NPI number — MARTIN E. SALM, M.D., LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN E. SALM, M.D., LTD
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:
ADVANCED COSMETIC SURGERY AND DERMATOLOGY
Provider Other Organization Name Type Code:
3
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:
1780856559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATELINE
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89449-5910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-588-5000
Provider Business Mailing Address Fax Number:
775-588-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 KINGSBURY GRADE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
STATELINE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89449-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-588-5000
Provider Business Practice Location Address Fax Number:
775-588-5001
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
775-588-5000

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  6357 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0101X , with the licence number: 6357 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X , with the licence number: 6357 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 6357 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002003058 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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