Provider Demographics
NPI:1821044850
Name:SOLARA HOSPITAL CONROE LP
Entity Type:Organization
Organization Name:SOLARA HOSPITAL CONROE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-621-6761
Mailing Address - Street 1:2200 ROSS AVE
Mailing Address - Street 2:SUITE 5400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2708
Mailing Address - Country:US
Mailing Address - Phone:469-621-6700
Mailing Address - Fax:469-621-6672
Practice Address - Street 1:1500 GRAND LAKE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2891
Practice Address - Country:US
Practice Address - Phone:936-523-1800
Practice Address - Fax:936-441-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008541282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452107Medicare Oscar/Certification