1154407823 NPI number — GREGORY F HOLLEY PA

Table of content: GREGORY F HOLLEY PA (NPI 1154407823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154407823 NPI number — GREGORY F HOLLEY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLEY
Provider First Name:
GREGORY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1154407823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 BLAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81601-4275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-945-8503
Provider Business Mailing Address Fax Number:
970-947-9048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 NORTH TAYLOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUNNISON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-641-1399
Provider Business Practice Location Address Fax Number:
970-641-9017
Provider Enumeration Date:
10/27/2006

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: 363A00000X , with the licence number:  PA1940 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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