1427033448 NPI number — DR. DAVID T HOLMES MD

Table of content: DR. DAVID T HOLMES MD (NPI 1427033448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427033448 NPI number — DR. DAVID T HOLMES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLMES
Provider First Name:
DAVID
Provider Middle Name:
T
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:
1427033448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 E GRUNDY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULLAHOMA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37388-3613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-455-2616
Provider Business Mailing Address Fax Number:
931-455-2280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E GRUNDY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULLAHOMA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37388-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-455-2616
Provider Business Practice Location Address Fax Number:
931-455-2280
Provider Enumeration Date:
12/13/2005

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: 2084P0800X , with the licence number:  01055252A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000216388 . This is a "IN ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200361790 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 880418970 . This is a "PRACTICE TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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