Healthcare Provider Details

I. General information

NPI: 1518920859
Provider Name (Legal Business Name): SALEM MEDICAL RESOURCES & SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HASLETT RD
HASLETT MI
48840-9779
US

IV. Provider business mailing address

5927 BUTTONWOOD DR
HASLETT MI
48840-9758
US

V. Phone/Fax

Practice location:
  • Phone: 517-896-9882
  • Fax: 517-339-5297
Mailing address:
  • Phone: 517-896-9882
  • Fax: 516-339-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNOT APPLICABLE
License Number StateMI

VIII. Authorized Official

Name: JERRY E CULLEN
Title or Position: PRESIDENT
Credential: PEDORTHISTS
Phone: 517-896-9882