Provider Demographics
NPI:1215396155
Name:SALUS MEDICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SALUS MEDICAL CONSULTANTS, LLC
Other - Org Name:PATRICK L BASILE, MD PLASTIC SURGERY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRAUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-222-6262
Mailing Address - Street 1:572 JACKSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3813
Mailing Address - Country:US
Mailing Address - Phone:904-222-6262
Mailing Address - Fax:904-302-8072
Practice Address - Street 1:572 JACKSONVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3813
Practice Address - Country:US
Practice Address - Phone:904-222-6262
Practice Address - Fax:904-302-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120272208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1C560ZMedicare PIN