Basic Information
| Provider Information | |||||||||
| NPI: | 1043205669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLCOMBE | ||||||||
| FirstName: | JOEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MICCOSUKEE ROAD | ||||||||
| Address2: | BIXLER EMERGENCY CENTER | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504310911 | ||||||||
| FaxNumber: | 8504310779 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 THOMASVILLE ROAD | ||||||||
| Address2: | PHYSICIAN BILLING OFFICE | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504317289 | ||||||||
| FaxNumber: | 8504316975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 06/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 049405 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME119322 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 52821815018 | 01 | GA | BCBS | OTHER | 338048 | 01 | GA | WELLCARE | OTHER | 056005018B | 05 | GA | MEDICAID | 52821815-019 | 01 | GA | BCBS | OTHER | 930103245 | 01 | GA | RAILROAD MEDICARE | OTHER | 000892383A | 05 | GA | MEDICAID | 056005018C | 05 | GA | MEDICAID |