Provider Demographics
NPI:1407850985
Name:SOLSTAS LAB PARTNERS GROUP LLC
Entity Type:Organization
Organization Name:SOLSTAS LAB PARTNERS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-227-0446
Mailing Address - Street 1:1201 S COLLEGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2998
Mailing Address - Country:US
Mailing Address - Phone:610-454-6147
Mailing Address - Fax:484-676-5309
Practice Address - Street 1:2906 JULIA DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1435
Practice Address - Country:US
Practice Address - Phone:229-244-4468
Practice Address - Fax:229-249-8191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUEST DIAGNOSTICS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092002291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00065Medicaid
FLL8165OtherBLUE CROSS BLUE SHIELD FL
GA00057164AMedicaid
GA52183605OtherBLUE CROSS BLUE SHIELD GA
AL600-27858OtherBLUE CROSS BLUE SHIELD AL
FL030253800Medicaid
AL065023369Medicaid
GA690005809Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AL600-27858OtherBLUE CROSS BLUE SHIELD AL