Provider Demographics
NPI:1053998575
Name:SENIORCARE IPA, LLC
Entity type:Organization
Organization Name:SENIORCARE IPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-366-1305
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1309
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8236
Mailing Address - Country:US
Mailing Address - Phone:832-366-1305
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1309
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8236
Practice Address - Country:US
Practice Address - Phone:832-366-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty