1336353457 NPI number — DR B. E. HOLMES PA

Table of content: (NPI 1336353457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336353457 NPI number — DR B. E. HOLMES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR B. E. HOLMES PA
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:
1336353457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 W FRONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONOKE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72086-3119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-676-6560
Provider Business Mailing Address Fax Number:
501-676-7166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 W FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONOKE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72086-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-676-6560
Provider Business Practice Location Address Fax Number:
501-676-7166
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
BYRON
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
501-676-6560

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C2033 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4979243001 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 4208778 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 011704651 . This is a "PALMETTO GBA-RAILROAD MED" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 111581002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103250001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61196 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 770014101 . This is a "BREASTCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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