=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518951573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS C HOLLOWAY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2005
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 W MAIN ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44875-1490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-342-1750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1469 SAND RIDGE RD
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43402-4493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-352-4065
-----------------------------------------------------
Fax | 419-352-4065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 35049753
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------