Provider Demographics
NPI:1750635090
Name:SOLARUS PAIN AND ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:SOLARUS PAIN AND ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:954-218-0180
Mailing Address - Street 1:12240 NW 28TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1717
Mailing Address - Country:US
Mailing Address - Phone:954-218-0180
Mailing Address - Fax:954-306-8844
Practice Address - Street 1:1749 NE 26TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1428
Practice Address - Country:US
Practice Address - Phone:954-218-0180
Practice Address - Fax:954-306-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107651261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004333000Medicaid