Basic Information
| Provider Information | |||||||||
| NPI: | 1669476321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALTER | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648596331 | ||||||||
| FaxNumber: | 8648593998 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 E 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648596331 | ||||||||
| FaxNumber: | 8648593998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 02/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 13668 | SC | N | Other Service Providers | Specialist | 208D00000X | 13668 | SC | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1528299732 | 01 | SC | OFFICE NPI NUMBER | OTHER | 136686 | 05 | SC | MEDICAID |