Provider Demographics
NPI:1215975438
Name:SALEM FAMILY MEDICINE INC
Entity type:Organization
Organization Name:SALEM FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-782-2000
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-0392
Mailing Address - Country:US
Mailing Address - Phone:304-782-2000
Mailing Address - Fax:304-782-3102
Practice Address - Street 1:RR 1 BOX 75-1
Practice Address - Street 2:OLD ROUTE 50 WEST
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-9604
Practice Address - Country:US
Practice Address - Phone:304-782-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15251207Q00000X
WV51D0725830291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9311801Medicare PIN