1730418880 NPI number — SOLIS WOMEN'S HEALTH BREAST IMAGING SPECIALISTS OF INDIANA, PC

Table of content: (NPI 1730418880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730418880 NPI number — SOLIS WOMEN'S HEALTH BREAST IMAGING SPECIALISTS OF INDIANA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLIS WOMEN'S HEALTH BREAST IMAGING SPECIALISTS OF INDIANA, PC
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:
Provider Other Organization Name Type Code:
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:
1730418880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15601 DALLAS PARKWAY
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-398-4100
Provider Business Mailing Address Fax Number:
469-398-4189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11450 NORTH MERIDIAN STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-872-3583
Provider Business Practice Location Address Fax Number:
317-844-2893
Provider Enumeration Date:
12/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KEHM
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING EMPLOYEE
Authorized Official Telephone Number:
469-398-4110

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201031120A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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