MEDICARE: MR. ALVIN ALLEN HOLMES JR. CSFA

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1679829584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALVIN ALLEN HOLMES JR. CSFA

Provider Business Mailing Address
First Line	:	6309 OLD FORT BAYOU RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8184
Country	:	US
Telephone Number	:	228-313-5781
Fax Number	:	228-376-0138

Provider Business Practice Location Address
First Line	:	6309 OLD FORT BAYOU RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8184
Country	:	US
Telephone Number	:	228-313-5781
Fax Number	:	228-376-0138

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

Provider Enumeration Date	:	07/28/2012
Last Update Date	:	07/28/2012

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