Basic Information
| Provider Information | |||||||||
| NPI: | 1225220460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLLEMAN SURGICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 HOSPITAL DR | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287228516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943300 | ||||||||
| FaxNumber: | 8288943377 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 HOSPITAL DR | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287228516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288943300 | ||||||||
| FaxNumber: | 8288943377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2007 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOLLEMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | BENNETT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8288943300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 98-00281 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1140X | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | DF0716 | 01 | RAILROAD MEDICARE | OTHER | 89066RK | 05 | NC | MEDICAID | NPB117 | 05 | SC | MEDICAID |