1740979640 NPI number — SOLACE MEDICAL CARE PLLC

Table of content: (NPI 1740979640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740979640 NPI number — SOLACE MEDICAL CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLACE MEDICAL CARE PLLC
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:
SOLACE ANESTHESIA PLLC
Provider Other Organization Name Type Code:
4
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:
1740979640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 ATHENS WAY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-633-1295
Provider Business Mailing Address Fax Number:
615-270-5011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 SHERIDAN DR STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-4845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-633-1295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FELDSTEIN
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
240-643-0900

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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