Healthcare Provider Details

I. General information

NPI: 1497848147
Provider Name (Legal Business Name): HOLLOWAY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 N. MERIDIAN AVENUE
OKLAHOMA CITY OK
73116
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-8450
  • Fax: 405-603-8455
Mailing address:
  • Phone: 414-423-4100
  • Fax: 405-603-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIS HOLLOWAY, JR
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 405-603-8450