Provider Demographics
NPI:1063593093
Name:SALEM SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:SALEM SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:540-772-3008
Mailing Address - Street 1:1898 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7301
Mailing Address - Country:US
Mailing Address - Phone:540-772-3008
Mailing Address - Fax:540-772-3352
Practice Address - Street 1:1898 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7301
Practice Address - Country:US
Practice Address - Phone:540-772-3008
Practice Address - Fax:540-772-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA256989OtherANTHEM
VAC06357Medicare ID - Type Unspecified