Provider Demographics
NPI:1164198446
Name:SALT RIVER MEDICAL LLC
Entity Type:Organization
Organization Name:SALT RIVER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-559-0892
Mailing Address - Street 1:PO BOX 12870
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850-2870
Mailing Address - Country:US
Mailing Address - Phone:888-709-3117
Mailing Address - Fax:302-709-2401
Practice Address - Street 1:4007 ESTATE DIAMOND RUBY
Practice Address - Street 2:
Practice Address - City:ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820-4435
Practice Address - Country:US
Practice Address - Phone:340-778-6311
Practice Address - Fax:340-772-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty