MEDICARE: DR. KEVIN H HOLMES 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
1	207R00000X	Internal Medicine Physician	15453	MS

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

General Provider Information

NPI Number	:	1942297858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN H HOLMES M.D.

Provider Business Mailing Address
First Line	:	104 PARTNERSHIP WAY
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-4502
Country	:	US
Telephone Number	:	601-736-6443
Fax Number	:	601-736-4641

Provider Business Practice Location Address
First Line	:	912 SUMRALL RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-2652
Country	:	US
Telephone Number	:	601-736-6443
Fax Number	:	601-736-2543

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	12/12/2016

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