Healthcare Provider Details

I. General information

NPI: 1467020396
Provider Name (Legal Business Name): SOLOMON GEBREMEDHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 FOREST LN # 468
DALLAS TX
75243-5905
US

IV. Provider business mailing address

6061 VILLAGE BEND DR APT 1003
DALLAS TX
75206-3553
US

V. Phone/Fax

Practice location:
  • Phone: 469-396-2012
  • Fax:
Mailing address:
  • Phone: 469-396-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: