MEDICARE: DR. MICHAEL W HOLMES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	5698	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ6730	OTHER	SC	RAILROAD MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL W HOLMES M.D.

Provider Business Mailing Address
First Line	:	479 HEYWOOD AVE
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307
Country	:	US
Telephone Number	:	864-583-6381
Fax Number	:	864-583-6390

Provider Business Practice Location Address
First Line	:	479 HEYWOOD AVE
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307
Country	:	US
Telephone Number	:	864-583-6381
Fax Number	:	864-583-6390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/22/2007

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