Look up the most recent NPI and PECOS records

Solomon Amdemariam Llc

Internal Medicine

Allopathic & Osteopathic Physicians

2000 W Bethany Home Rd, Phoenix, AZ 85015-2443

PECOS Enrollment

Based on the most recent information from CMS, provider Solomon Amdemariam Llc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1801958616
Provider Type
Organization
Full Name
Solomon Amdemariam Llc

Subpart
No
Enumeration Date
12/15/2006
Last Updated
8/22/2020

Contact Information

Practice Location

2000 W Bethany Home Rd, Phoenix, AZ 85015-2443

(623) 594-7866

Unlisted Fax

Mailing Location

20280 N 59th Ave, Suite # 115 Pmb 544, Glendale, AZ 85308-6850

(623) 594-7866

Unlisted Fax

Authorized Official

Amdemariam, Solomon (Owner)

(623) 698-6741

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 31855 Arizona

Solomon Amdemariam Llc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

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