Provider Demographics
NPI:1154602399
Name:SOLE CARE LLC
Entity type:Organization
Organization Name:SOLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-390-5607
Mailing Address - Street 1:5660 W POTTER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9164
Mailing Address - Country:US
Mailing Address - Phone:602-390-5608
Mailing Address - Fax:623-933-5787
Practice Address - Street 1:5660 W POTTER DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9164
Practice Address - Country:US
Practice Address - Phone:602-390-5608
Practice Address - Fax:623-933-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty