Provider Demographics
NPI:1932354883
Name:SOLARUS MEDICAL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SOLARUS MEDICAL ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-762-7468
Mailing Address - Street 1:10347 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2993
Mailing Address - Country:US
Mailing Address - Phone:816-746-1901
Mailing Address - Fax:888-405-5893
Practice Address - Street 1:12127 BLUE RIDGE EXT STE A
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1106
Practice Address - Country:US
Practice Address - Phone:888-994-6688
Practice Address - Fax:888-405-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNOT APPLICABLE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1932354883OtherHUMANA
MO1932354883OtherBEECHSTREET
MO1932354883OtherCOVENTRY HEALTHCARE OF KANSAS INC.
MO1932354883OtherCENTURY
MO1932354883OtherGREAT WEST HEALTHCARE
KS200589760AMedicaid
MO1932354883OtherTRICARE/TRIWEST
MO1932354883OtherUNICARE MEDICAID
KS1932354883OtherUNICARE MEDICAID
MO1932354883Medicaid
IA1932354883Medicaid
MO42107013OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
MO1932354883OtherTRICARE/TRIWEST
MO1932354883Medicaid