1821020421 NPI number — SOLIS HEALTHCARE, LP

Table of content: (NPI 1821020421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821020421 NPI number — SOLIS HEALTHCARE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLIS HEALTHCARE, LP
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:
ROXBOROUGH MEMORIAL HOSPITAL
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:
1821020421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 RIDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19128-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-487-4245
Provider Business Mailing Address Fax Number:
215-487-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 RIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-487-4245
Provider Business Practice Location Address Fax Number:
215-487-4274
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONNELLY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
215-487-4245

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 910401 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09801 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1430 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1019096660001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390304B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1757000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 318955 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9801 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0062197 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1500883 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30042522 . This is a "KEYSTONE MERCY HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11056A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005633000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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