1720021199 NPI number — DR. EDWARD J HOLLAND MD

Table of content: DR. EDWARD J HOLLAND MD (NPI 1720021199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720021199 NPI number — DR. EDWARD J HOLLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
EDWARD
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1720021199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 S LOOP RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-569-3741
Provider Business Mailing Address Fax Number:
513-569-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 S LOOP RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-569-3741
Provider Business Practice Location Address Fax Number:
513-569-3941
Provider Enumeration Date:
06/14/2006

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: 207W00000X , with the licence number:  35077410 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 35605 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4046569 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64004476 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000075280 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180038905 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2152316 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01484326 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810009070 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81958100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180038906 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200259180 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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