1154514149 NPI number — HOLDAWAY MEDICAL SERVICES, LLC

Table of content: (NPI 1154514149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154514149 NPI number — HOLDAWAY MEDICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLDAWAY MEDICAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154514149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 CONSTANT COMMENT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40299-6323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-397-0525
Provider Business Mailing Address Fax Number:
502-266-9736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 METROPLEX DR
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-331-6417
Provider Business Practice Location Address Fax Number:
615-331-6417
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-397-0525

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  00002688 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com