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General NPI Number Information
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NPI Number | 1821813973
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Entity Type | Organization
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Legal Business Name | SOLARIS DX 2 LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1630 GEORGETOWN RD STE 1
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City | TILTON
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State | IL
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Zip | 61833-8110
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Country | US
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Telephone | 217-655-4201
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Fax | 859-305-6105
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Provider Business Mailing Address
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Address Line | 1630 GEORGETOWN RD STE 1
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City | TILTON
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State | IL
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Zip | 61833-8110
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Country | US
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Telephone | 217-655-4201
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Fax | 859-305-6105
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Authorized Official
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Title or Position | CEO
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Name | MR. ZACHARY AEBERSOLD
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Credential |
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Telephone | 217-655-4201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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