Provider Demographics
NPI:1528193612
Name:SOLLLC
Entity Type:Organization
Organization Name:SOLLLC
Other - Org Name:OWOSSO HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THURKOW
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:989-725-8114
Mailing Address - Street 1:218 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-3040
Mailing Address - Country:US
Mailing Address - Phone:989-725-8114
Mailing Address - Fax:989-725-8121
Practice Address - Street 1:218 N PARK ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-3040
Practice Address - Country:US
Practice Address - Phone:989-725-8114
Practice Address - Fax:989-725-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501001505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH10288OtherBLUE CARE NETWORK
MI540H102880OtherBLUE CROSS