Provider Demographics
NPI:1255717617
Name:MARY S. SALTER, MD PSC
Entity type:Organization
Organization Name:MARY S. SALTER, MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-766-9281
Mailing Address - Street 1:P.O. BOX 1155
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601
Mailing Address - Country:US
Mailing Address - Phone:218-766-9281
Mailing Address - Fax:888-375-3627
Practice Address - Street 1:514 BELTRAMI AVE NW SUITE 102
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-444-7172
Practice Address - Fax:888-375-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty