=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134963697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL R. HOLLAND, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2024
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL DRIVE, SUITE 100
-----------------------------------------------------
City | JENNINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70546-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-824-3819
-----------------------------------------------------
Fax | 337-824-0160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HOSPITAL DRIVE, SUITE 100
-----------------------------------------------------
City | JENNINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70546-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-824-3819
-----------------------------------------------------
Fax | 337-824-0160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MICHAEL RYBURN HOLLAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 337-824-3818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------