Provider Demographics
NPI:1609822592
Name:SOLANTIC LLC
Entity Type:Organization
Organization Name:SOLANTIC LLC
Other - Org Name:SOLANTIC CORPORATE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-223-2320
Mailing Address - Street 1:8711 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6388
Mailing Address - Country:US
Mailing Address - Phone:904-223-2330
Mailing Address - Fax:904-223-3149
Practice Address - Street 1:8711 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6388
Practice Address - Country:US
Practice Address - Phone:904-223-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34191Medicare ID - Type Unspecified