Healthcare Provider Details

I. General information

NPI: 1972142503
Provider Name (Legal Business Name): JAMES CEDRICK HOLDEN III PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 4TH ST SW SUITE 105
MASON CITY IA
50401-2857
US

IV. Provider business mailing address

600 1ST ST NW SUITE 101
MASON CITY IA
50401-2932
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7847
  • Fax: 614-428-7999
Mailing address:
  • Phone: 641-428-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number108393
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: