MEDICARE: SOLARIS, 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1780721159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARIS, INC.

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 3260
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-918-9180
Fax Number	:	414-918-9189

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 3260
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-918-9180
Fax Number	:	414-918-9189

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHY JO WEATHERLY
Credential	:	OTR
Telephone Number	:	414-918-9180

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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