Basic Information
| Provider Information | |||||||||
| NPI: | 1699817114 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SALTZER MEDICAL GROUP PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 W GEORGIA AVE | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836866811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084633234 | ||||||||
| FaxNumber: | 2084633044 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 E FLAMINGO AVE | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836879203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884970 | ||||||||
| FaxNumber: | 2084633044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 06/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | MALLOY | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2084633103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.