=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144671587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALAMEH PLASTIC SURGERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2016
-----------------------------------------------------
Last Update Date | 07/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 996 WILKINSON TRCE STE C1
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42103-3410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-904-7791
-----------------------------------------------------
Fax | 270-904-7230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1220
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42102-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-745-1100
-----------------------------------------------------
Fax | 270-745-1156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | BERNARD SALAMEH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 402-547-7655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------