Healthcare Provider Details

I. General information

NPI: 1871636746
Provider Name (Legal Business Name): MARIUM GRACE HOLLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIUM HOLLAND SMITH M.D.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS 2028
KANSAS CITY KS
66160-7316
US

IV. Provider business mailing address

3901 RAINBOW BLVD MS 4017
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-6462
  • Fax:
Mailing address:
  • Phone: 913-588-6200
  • Fax: 913-588-6271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-36471
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN0838
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number04-36471
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: