Provider Demographics
NPI:1205881125
Name:SOLARA HOSPITAL SHAWNEE, LLC
Entity type:Organization
Organization Name:SOLARA HOSPITAL SHAWNEE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:2200 ROSS AVE
Mailing Address - Street 2:STE 5400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7918
Mailing Address - Country:US
Mailing Address - Phone:469-621-6700
Mailing Address - Fax:469-621-6678
Practice Address - Street 1:1900 GORDON COOPER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-8603
Practice Address - Country:US
Practice Address - Phone:405-395-5800
Practice Address - Fax:405-395-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2363282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200080160AMedicaid
OK200080160AMedicaid