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NPI Code Detail

MEDICARE: WARREN H HOLLEY M.D.

MEDICARE: WARREN H HOLLEY 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
1207RC0000XCardiovascular Disease Physician13116AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5060015749OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2209445OTHERBLACK LUNG PROGRAM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
451089287OTHERALBC/BS OF ALABAMA

General Provider Information

NPI Number : 1194719567
Entity Type Code : Individual
Provider Name (Legal Business Name) : WARREN H HOLLEY M.D.
Provider Business Mailing Address
First Line : 4401 WATERMELON RD
Second Line :
City : NORTHPORT
State : AL
Zip : 35473-5197
Country : US
Telephone Number : 205-343-2811
Fax Number : 205-391-0900
Provider Business Practice Location Address
First Line : 4401 WATERMELON RD
Second Line :
City : NORTHPORT
State : AL
Zip : 35473-5197
Country : US
Telephone Number : 205-343-2811
Fax Number : 205-391-0900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 03/01/2010

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