Provider Demographics
NPI:1710347349
Name:SOLSTICE MEDICINE & WELLNESS, LLC
Entity Type:Organization
Organization Name:SOLSTICE MEDICINE & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-978-5733
Mailing Address - Street 1:3875 GEIST RD STE E154
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3564
Mailing Address - Country:US
Mailing Address - Phone:907-456-6334
Mailing Address - Fax:907-456-6336
Practice Address - Street 1:475 RIVERSTONE WAY STE 2
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2971
Practice Address - Country:US
Practice Address - Phone:907-456-6334
Practice Address - Fax:907-456-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1032552261QM2500X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1011882Medicaid