MEDICARE: SOLERA HEALTH SERVICES, INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	64202804	IL

General Provider Information

NPI Number	:	1619174018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLERA HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1645 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2133
Country	:	US
Telephone Number	:	630-271-1911
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. OLIVIA F ACOSTA
Credential	:	RCP
Telephone Number	:	630-271-1911

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/22/2020

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