Healthcare Provider Details

I. General information

NPI: 1801862750
Provider Name (Legal Business Name): HOLLADAY MEDICORP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 LANDMARK DR
WINSTON-SALEM NC
27103-6717
US

IV. Provider business mailing address

2551 LANDMARK DR
WINSTON-SALEM NC
27103-6717
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-2111
  • Fax: 336-768-7731
Mailing address:
  • Phone: 336-760-2111
  • Fax: 336-768-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852