1205881125 NPI number — SOLARA HOSPITAL SHAWNEE, LLC

Table of content: (NPI 1205881125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205881125 NPI number — SOLARA HOSPITAL SHAWNEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLARA HOSPITAL SHAWNEE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNERSTONE SPECIALTY HOSPITALS SHAWNEE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205881125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 ROSS AVE
Provider Second Line Business Mailing Address:
STE 5400
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-7918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-621-6700
Provider Business Mailing Address Fax Number:
469-621-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 GORDON COOPER DR
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74801-8603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-395-5800
Provider Business Practice Location Address Fax Number:
405-395-5802
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official Telephone Number:
629-253-5121

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  2363 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200080160A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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