MEDICARE: STAN SOLOMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1124496195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAN SOLOMON

Provider Business Mailing Address
First Line	:	114 TRADE CENTER DR STE A
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-1690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 TRADE CENTER DR STE A
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-1690
Country	:	US
Telephone Number	:	205-987-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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Directions to “ STAN SOLOMON ” Practice Location

Language	Start Address	Practice Location

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