MEDICARE: SOLARA MEDICAL SUPPLIES, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235504440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARA MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	220 W GERMANTOWN PIKE STE 250
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1437
Country	:	US
Telephone Number	:	610-630-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	9550 FOREST LN STE 474
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-5905
Country	:	US
Telephone Number	:	800-999-7516
Fax Number	:	800-999-7021

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN GRIGGS
Credential	:
Telephone Number	:	407-206-0040

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	04/28/2021

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Directions to “SOLARA MEDICAL SUPPLIES, LLC ” Practice Location

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