Provider Demographics
NPI:1073981221
Name:SALEM AVE HEALTH SYSTEM
Entity Type:Organization
Organization Name:SALEM AVE HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-261-3422
Mailing Address - Street 1:1802 NE JENSEN BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-7234
Mailing Address - Country:US
Mailing Address - Phone:772-252-1235
Mailing Address - Fax:772-934-8300
Practice Address - Street 1:141 SALEM AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2574
Practice Address - Country:US
Practice Address - Phone:772-252-1235
Practice Address - Fax:772-934-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty