1942400270 NPI number — DR. DAVID C SOLLY D.ED.

Table of content: DR. DAVID C SOLLY D.ED. (NPI 1942400270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942400270 NPI number — DR. DAVID C SOLLY D.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLLY
Provider First Name:
DAVID
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.ED.
Provider Gender Code:
M

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:
1942400270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7855 PINE CONE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80908-6117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-338-4665
Provider Business Mailing Address Fax Number:
719-495-7458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 OFFICE CLUB PT
Provider Second Line Business Practice Location Address:
SUITE 4300
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-272-8310
Provider Business Practice Location Address Fax Number:
719-282-6006
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2835 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16580 . This is a "USAA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31877265 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00179191 . This is a "RAILROAD MEDICARE (PALMET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 673556 . This is a "ANTHEM AMIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 229050 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61-00623 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".




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