1609193192 NPI number — SOLARUS ENTERPRISES, LLC

Table of content: (NPI 1609193192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609193192 NPI number — SOLARUS ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLARUS ENTERPRISES, 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:
SOLARUS MEDICAL
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:
1609193192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10347 CROSS CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-2993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-994-6688
Provider Business Mailing Address Fax Number:
866-342-9716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4109 CITY POINT DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76180-8339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-994-6688
Provider Business Practice Location Address Fax Number:
866-342-9716
Provider Enumeration Date:
04/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ELDER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
813-994-6688

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  NOT APPLICABLE , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 217910303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA . This is a "BLUE CROSS BLUE SHIELD OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "HEALTHSMART" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "ASSURANT HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: N/A . This is a "RIGHT CARE - SCOTT & WHITE HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PARKLAND COMMUNITY HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "GREAT-WEST HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "FIRSTCARE HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "MOLINA OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "MULTI PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PRIME HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "UNIVERSAL HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: N/A . This is a "COOK CHILDREN'S HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "UMR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NA . This is a "PHCS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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