Provider Demographics
NPI:1487488110
Name:SALVEO MEDICINE LLC
Entity type:Organization
Organization Name:SALVEO MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-293-8403
Mailing Address - Street 1:485 STATE ROAD 13 N STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2993
Mailing Address - Country:US
Mailing Address - Phone:239-293-8403
Mailing Address - Fax:239-293-8403
Practice Address - Street 1:6100 GREENLAND RD STE 903
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7450
Practice Address - Country:US
Practice Address - Phone:239-293-8403
Practice Address - Fax:239-293-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME142810OtherFLORIDA BOARD OF MEDICINE
FL105061000Medicaid