MEDICARE: HERBERT K HOLDSAMBECK 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	207Q00000X	Family Medicine Physician	10399	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110019467	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0004003561	OTHER		AETNA
3	510 16799	OTHER	AL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	63 0969203	OTHER		TAX IDENTIFICATION NO

General Provider Information

NPI Number	:	1649251216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERBERT K HOLDSAMBECK MD

Provider Business Mailing Address
First Line	:	420 LOWELL DR SE
Second Line	:	STE 103
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3754
Country	:	US
Telephone Number	:	256-535-5940
Fax Number	:	256-535-5954

Provider Business Practice Location Address
First Line	:	420 LOWELL DR SE
Second Line	:	STE 403
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3754
Country	:	US
Telephone Number	:	256-535-5980
Fax Number	:	256-535-5983

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/07/2009

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Directions to “ HERBERT K HOLDSAMBECK MD” Practice Location

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