Healthcare Provider Details

I. General information

NPI: 1154863231
Provider Name (Legal Business Name): RSS JON HOLMAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE BLDG 100, SUITE 100
OKLAHOMA CITY OK
73120-9369
US

IV. Provider business mailing address

1050 TEXAN TRL SUITE 300
GRAPEVINE TX
76051-3741
US

V. Phone/Fax

Practice location:
  • Phone: 405-486-7879
  • Fax: 855-829-4625
Mailing address:
  • Phone: 469-778-6100
  • Fax: 866-300-4682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4246
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOK

VIII. Authorized Official

Name: JAMES R EVANGER
Title or Position: CEO
Credential:
Phone: 904-469-3119