MEDICARE: CYNTHIA LOUISE HOLMES PA-C

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	363A00000X	Physician Assistant	PA01102	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	381902	OTHER		FQHC MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619915113	OTHER		WATERFALL CLINIC, INC. GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932150471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LOUISE HOLMES PA-C

Provider Business Mailing Address
First Line	:	1890 WAITE ST
Second Line	:	SUITE 1
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1229
Country	:	US
Telephone Number	:	541-756-6232
Fax Number	:	541-756-6234

Provider Business Practice Location Address
First Line	:	1890 WAITE ST
Second Line	:	SUITE 1
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1229
Country	:	US
Telephone Number	:	541-756-6232
Fax Number	:	541-756-6234

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/21/2013

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Directions to “ CYNTHIA LOUISE HOLMES PA-C” Practice Location

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