Provider Demographics
NPI:1730476979
Name:SOLOMON VALLEY FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:SOLOMON VALLEY FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-259-6417
Mailing Address - Street 1:1210 N. WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-1632
Mailing Address - Country:US
Mailing Address - Phone:785-259-6417
Mailing Address - Fax:785-434-2577
Practice Address - Street 1:1210 N. WASHINGTON
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-1632
Practice Address - Country:US
Practice Address - Phone:785-259-6417
Practice Address - Fax:785-434-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicaid
KSPENDINGOtherBCBS
KSPENDINGOtherMEDICARE