Provider Demographics
NPI:1760697536
Name:SOLO FLYER, INC.
Entity Type:Organization
Organization Name:SOLO FLYER, INC.
Other - Org Name:ROEBUCK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-587-0200
Mailing Address - Street 1:2001 E. BLACKSTOCK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2734
Mailing Address - Country:US
Mailing Address - Phone:864-587-0200
Mailing Address - Fax:864-587-0300
Practice Address - Street 1:2001 E BLACKSTOCK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2734
Practice Address - Country:US
Practice Address - Phone:864-587-0200
Practice Address - Fax:864-587-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH76942Medicare UPIN
SCH76690Medicare UPIN
SC7674Medicare PIN