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General NPI Number Information
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NPI Number | 1215975438
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Entity Type | Organization
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Legal Business Name | SALEM FAMILY MEDICINE INC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | RR 1 BOX 75-1 OLD ROUTE 50 WEST
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City | SALEM
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State | WV
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Zip | 26426-9604
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Country | US
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Telephone | 304-782-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | SALEM
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State | WV
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Zip | 26426-0392
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Country | US
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Telephone | 304-782-2000
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Fax | 304-782-3102
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LYDIA JEAN SOLOMON
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Credential |
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Telephone | 304-782-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 51D0725830
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15251
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License Number State | WV
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