MEDICARE: SOLUTA HEALTH

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	261Q00000X	Clinic/Center	207Q00000X	TX

General Provider Information

NPI Number	:	1750753331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLUTA HEALTH

Provider Business Mailing Address
First Line	:	9401 AMBERGLEN BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-1154
Country	:	US
Telephone Number	:	512-454-2681
Fax Number	:

Provider Business Practice Location Address
First Line	:	9401 AMBERGLEN BLVD
Second Line	:	BLDG 1 SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78729-1154
Country	:	US
Telephone Number	:	512-454-2681
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NYLE LEFTWICH
Credential	:
Telephone Number	:	512-233-7227

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	10/22/2015

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