Provider Demographics
NPI:1821813973
Name:SOLARIS DX 2 LLC
Entity type:Organization
Organization Name:SOLARIS DX 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AEBERSOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-655-4201
Mailing Address - Street 1:1630 GEORGETOWN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:IL
Mailing Address - Zip Code:61833-8110
Mailing Address - Country:US
Mailing Address - Phone:217-655-4201
Mailing Address - Fax:859-305-6105
Practice Address - Street 1:1630 GEORGETOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:IL
Practice Address - Zip Code:61833-8110
Practice Address - Country:US
Practice Address - Phone:217-655-4201
Practice Address - Fax:859-305-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory