1023003480 NPI number — DR. LOUIS G SALIB MD

Table of content: DR. LOUIS G SALIB MD (NPI 1023003480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023003480 NPI number — DR. LOUIS G SALIB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALIB
Provider First Name:
LOUIS
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1023003480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4135 BOARDMAN CANFIELD RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-9803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-286-5330
Provider Business Mailing Address Fax Number:
330-286-5396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
667 EASTLAND AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-841-4100
Provider Business Practice Location Address Fax Number:
330-841-4455
Provider Enumeration Date:
09/13/2005

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: 207LP2900X , with the licence number:  35060114 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 35060114S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0914201 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H128111 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 11329214 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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