Healthcare Provider Details

I. General information

NPI: 1518238518
Provider Name (Legal Business Name): SALEM MEDICAL PRACTICE MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E NORTH 1ST ST
SENECA SC
29678-3240
US

IV. Provider business mailing address

107 E NORTH 1ST ST
SENECA SC
29678-3240
US

V. Phone/Fax

Practice location:
  • Phone: 864-985-0808
  • Fax: 864-985-0525
Mailing address:
  • Phone: 864-985-0808
  • Fax: 864-985-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DALLAS VANCE MARTIN
Title or Position: ADMINISTRATOR
Credential: M.S.
Phone: 864-985-0808