Healthcare Provider Details

I. General information

NPI: 1528045101
Provider Name (Legal Business Name): HOLDAWAY MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CONSTANT COMMENT PL
LOUISVILLE KY
40299-6323
US

IV. Provider business mailing address

2500 CONSTANT COMMENT PL
LOUISVILLE KY
40299-6323
US

V. Phone/Fax

Practice location:
  • Phone: 502-266-0092
  • Fax: 502-266-9736
Mailing address:
  • Phone: 502-266-0092
  • Fax: 502-266-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WEST
Title or Position: CEO
Credential:
Phone: 502-266-0092