Provider Demographics
NPI:1013031947
Name:TRES SOLES MEDICAL CLINIC & SPA, LLC
Entity Type:Organization
Organization Name:TRES SOLES MEDICAL CLINIC & SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STONER-BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-742-4100
Mailing Address - Street 1:503 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2221
Mailing Address - Country:US
Mailing Address - Phone:785-742-4100
Mailing Address - Fax:785-742-4101
Practice Address - Street 1:503 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2221
Practice Address - Country:US
Practice Address - Phone:785-742-4100
Practice Address - Fax:785-742-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service