Provider Demographics
NPI:1740617620
Name:SOUTHPOINT STAR LLC
Entity Type:Organization
Organization Name:SOUTHPOINT STAR LLC
Other - Org Name:SOLUTION HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-240-4585
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:STE 1704
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-240-4585
Mailing Address - Fax:800-388-0270
Practice Address - Street 1:6817 SOUTHPOINT PKWY
Practice Address - Street 2:STE 1704
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6282
Practice Address - Country:US
Practice Address - Phone:904-240-4585
Practice Address - Fax:800-388-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94099208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty