Organization Name: | TRES SOLES MEDICAL CLINIC & SPA, LLC |
NPI Number: | 1013031947 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBORAH DIANE STONER-BRYAN (OWNER) |
Mailing Address: | 503 Oregon St Hiawatha |
State: | KS US |
Postal Code: | 664342221 |
Phone Number: | 7857424100 |
Fax Number: | 7857424101 |
NPI Enumeration Date: | 03/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |