MEDICARE: SETH JAMES HOLMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0010-03245	NC
2	363A00000X	Physician Assistant	55-002080	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437429693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH JAMES HOLMAN PA-C

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:	937-619-4150

Provider Business Practice Location Address
First Line	:	154 HEALTH PARTNERS CIR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8611
Country	:	US
Telephone Number	:	513-981-4700
Fax Number	:	937-619-4150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	10/06/2014

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