1922539048 NPI number — DR. SARAH RUTH HOLLIS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922539048 NPI number — DR. SARAH RUTH HOLLIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLIS
Provider First Name:
SARAH
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLY
Provider Other First Name:
SARAH
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922539048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47732-3395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-732-6956
Provider Business Mailing Address Fax Number:
502-732-8219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 MARWILL DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-732-6956
Provider Business Practice Location Address Fax Number:
502-732-8219
Provider Enumeration Date:
03/21/2017

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: 207Q00000X , with the licence number:  53832 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K328361 . This is a "MEDICARE EFFECT 10/25/22" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100677750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300098597 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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