1477599959 NPI number — DR. JAMES HOLEHOUSE M.D.

Table of content: DR. JAMES HOLEHOUSE M.D. (NPI 1477599959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477599959 NPI number — DR. JAMES HOLEHOUSE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLEHOUSE
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1477599959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26537-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-333-8385
Provider Business Mailing Address Fax Number:
304-333-8332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SOUTHLAND DR
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554-2244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-333-8385
Provider Business Practice Location Address Fax Number:
304-333-8332
Provider Enumeration Date:
06/21/2006

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: 207V00000X , with the licence number:  15258 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0091377000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001710365 . This is a "BCBS FOR PMMG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: WV15258C . This is a "HEALTHPLAN PMMG" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".