MEDICARE: DR. ADELE B HOLMES MD

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	208000000X	Pediatrics Physician	E0670	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5902223	OTHER	AR	AETNA PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5K100	OTHER	AR	BCBS PRIVIDER ID
4	1220059	OTHER	AR	UNITED HEALTH CARE ID#
5	16838000000	OTHER	AR	QUALCHOICE PRIOVIDER ID

General Provider Information

NPI Number	:	1154383958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADELE B HOLMES MD

Provider Business Mailing Address
First Line	:	2301 SPRINGHILL ROAD
Second Line	:	SUITE 200
City	:	BENTON
State	:	AR
Zip	:	72019
Country	:	US
Telephone Number	:	501-315-0078
Fax Number	:	501-943-3016

Provider Business Practice Location Address
First Line	:	2301 SPRINGHILL ROAD
Second Line	:	SUITE 200
City	:	BENTON
State	:	AR
Zip	:	72019
Country	:	US
Telephone Number	:	501-315-0078
Fax Number	:	501-943-3016

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	01/25/2011

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