1538284138 NPI number — HOLLADAY & ASSOCIATES, LLC

Table of content: (NPI 1538284138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538284138 NPI number — HOLLADAY & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLLADAY & ASSOCIATES, 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:
HOLLADAY & ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1538284138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
634 S BAILEY ST STE 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99645-6360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-745-7080
Provider Business Mailing Address Fax Number:
907-745-6263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 S BAILEY ST STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645-6360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-745-7080
Provider Business Practice Location Address Fax Number:
907-745-6263
Provider Enumeration Date:
03/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MINER-COLLINS
Authorized Official First Name:
JANA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
907-745-7080

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  86 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 77 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 2442 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 241 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MH9931 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".