Basic Information
| Provider Information | |||||||||
| NPI: | 1548292360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLOWAY | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ROBIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | YORK | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | ROBIN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16605 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 400 MOB3 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812750800 | ||||||||
| FaxNumber: | 2812750801 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 W 18TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770081289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134260027 | ||||||||
| FaxNumber: | 7134260211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L3341 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207V00000X | L3341 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | L3341 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 158222305 | 05 | TX | MEDICAID | P00846068 | 01 | TX | MEDICARE RAILROAD | OTHER | 158222304 | 05 | TX | MEDICAID | P01030998 | 01 | TX | RR MEDICARE | OTHER | 1548292360 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |