Provider Demographics
NPI:1689863722
Name:SALLI SMITH SLONE, MD, PSC
Entity Type:Organization
Organization Name:SALLI SMITH SLONE, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:SALLI
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:SLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-0916
Mailing Address - Street 1:P O BOX 6
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0006
Mailing Address - Country:US
Mailing Address - Phone:859-236-0916
Mailing Address - Fax:859-236-0917
Practice Address - Street 1:111 DANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2527
Practice Address - Country:US
Practice Address - Phone:859-236-0916
Practice Address - Fax:859-236-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32347207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6435OtherMEDICARE GROUP
KY65907677Medicaid
KY65907677Medicaid