1225220460 NPI number — HOLLEMAN SURGICAL

Table of content: (NPI 1225220460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225220460 NPI number — HOLLEMAN SURGICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLLEMAN SURGICAL
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:
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:
1225220460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28722-8516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-894-3300
Provider Business Mailing Address Fax Number:
828-894-3377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28722-8516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-894-3300
Provider Business Practice Location Address Fax Number:
828-894-3377
Provider Enumeration Date:
08/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLEMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
BENNETT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-894-3300

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  98-00281 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1140X . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DF0716 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89066RK , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB117 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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