1356546790 NPI number — DR. TIMOTHY RYAN HOLMES D.P.M.

Table of content: DR. TIMOTHY RYAN HOLMES D.P.M. (NPI 1356546790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356546790 NPI number — DR. TIMOTHY RYAN HOLMES D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLMES
Provider First Name:
TIMOTHY
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

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:
1356546790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 BEECHER XING N
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-4573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-304-0019
Provider Business Mailing Address Fax Number:
614-304-0023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 REFUGEE RD
Provider Second Line Business Practice Location Address:
SUITE 295
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-9755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-545-4321
Provider Business Practice Location Address Fax Number:
614-545-4324
Provider Enumeration Date:
06/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  36.003465 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00651126 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2458648 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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