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1316977804

NPI Code Detail

MEDICARE: ERNEST SAMUEL HOLMES IV MD

MEDICARE: ERNEST SAMUEL HOLMES IV 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	115096	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	115234	OTHER	MO	ANTHEM

General Provider Information

NPI Number	:	1316977804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST SAMUEL HOLMES IV MD

Provider Business Mailing Address
First Line	:	PO BOX 3810
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64803
Country	:	US
Telephone Number	:	417-451-0778
Fax Number	:	417-451-0779

Provider Business Practice Location Address
First Line	:	336 S JEFFERSON ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-1769
Country	:	US
Telephone Number	:	417-451-0778
Fax Number	:	417-451-0779

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/17/2011

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Directions to “ ERNEST SAMUEL HOLMES IV MD” Practice Location

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