1932354883 NPI number — SOLARUS MEDICAL ENTERPRISES, LLC

Table of content: (NPI 1932354883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932354883 NPI number — SOLARUS MEDICAL ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLARUS MEDICAL 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:
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:
1932354883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2020
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:
816-746-1901
Provider Business Mailing Address Fax Number:
888-405-5893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12127 BLUE RIDGE EXT STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64030-1106
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:
888-405-5893
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ELDER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-762-7468

Provider Taxonomy Codes

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

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

  • Identifier: 1932354883 . This is a "HUMANA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "BEECHSTREET" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "COVENTRY HEALTHCARE OF KANSAS INC." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "CENTURY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 200589760A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932354883 . This is a "TRICARE/TRIWEST" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "UNICARE MEDICAID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 . This is a "UNICARE MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1932354883 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932354883 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42107013 . This is a "BLUE CROSS BLUE SHIELD OF KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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