1841514684 NPI number — MR. JAMES KEVIN HOLLAND SR. RPH

Table of content: (NPI 1366913337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841514684 NPI number — MR. JAMES KEVIN HOLLAND SR. RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLAND
Provider First Name:
JAMES
Provider Middle Name:
KEVIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
RPH
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:
1841514684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 RED OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46033-1973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-489-1340
Provider Business Mailing Address Fax Number:
317-585-2465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8375 E 96TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-585-2433
Provider Business Practice Location Address Fax Number:
317-585-2465
Provider Enumeration Date:
03/23/2010

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: 183500000X , with the licence number:  26018954 , 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)





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