1043291289 NPI number — H DOUGLAS HOLLIDAY MD PLLC

Table of content: (NPI 1043291289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043291289 NPI number — H DOUGLAS HOLLIDAY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H DOUGLAS HOLLIDAY MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1043291289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 GLEN ECHO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-373-9505
Provider Business Mailing Address Fax Number:
615-373-9505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 GLEN ECHO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37215-2807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-727-8796
Provider Business Practice Location Address Fax Number:
615-727-8798
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIDAY
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
615-727-8796

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  10586 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4019725 . This is a "BLUECROSS BLUESHIELD OF T" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0440761 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4294542 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002528 . This is a "AMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3170434 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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