Healthcare Provider Details

I. General information

NPI: 1235190232
Provider Name (Legal Business Name): HOLLAND MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAX HURT DR
MURRAY KY
42071-7847
US

IV. Provider business mailing address

PO BOX 27968
SALT LAKE CITY UT
84127-0968
US

V. Phone/Fax

Practice location:
  • Phone: 270-767-8638
  • Fax: 270-753-6339
Mailing address:
  • Phone: 863-603-0033
  • Fax: 863-682-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ROBIN L MENCHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 407-822-4600