Healthcare Provider Details

I. General information

NPI: 1215975438
Provider Name (Legal Business Name): SALEM FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 75-1 OLD ROUTE 50 WEST
SALEM WV
26426-9604
US

IV. Provider business mailing address

PO BOX 392
SALEM WV
26426-0392
US

V. Phone/Fax

Practice location:
  • Phone: 304-782-2000
  • Fax:
Mailing address:
  • Phone: 304-782-2000
  • Fax: 304-782-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number51D0725830
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15251
License Number StateWV

VIII. Authorized Official

Name: LYDIA JEAN SOLOMON
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-782-2000