Provider Demographics
NPI:1356710461
Name:SALUS VIRTUAL CARE CLINIC
Entity type:Organization
Organization Name:SALUS VIRTUAL CARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-285-0902
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0285
Mailing Address - Country:US
Mailing Address - Phone:912-285-0902
Mailing Address - Fax:912-285-0904
Practice Address - Street 1:914 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-2917
Practice Address - Country:US
Practice Address - Phone:912-285-0902
Practice Address - Fax:912-285-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center