Provider Demographics
NPI:1104893148
Name:HOLT, EDWIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MICHAEL
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ACCELERATOR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3078
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1600 ACCELERATOR WAY STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3078
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0179OtherJOHN DEERE HEALTHCARE
TN100021361OtherTENNCARE
TN3047936Medicaid
TN0940098OtherUNITED HEALTH CARE
TN4664609OtherAETNA
TNTN0105OtherJOHN DEERE HEALTHCARE
TN3071402OtherBLUE CROSS BLUE SHIELD
KY64123805Medicaid
TNTN0106OtherJOHN DEERE HEALTHCARE
TN200029382OtherRAILROAD MEDICARE
3047939Medicare ID - Type Unspecified
TN3071402OtherBLUE CROSS BLUE SHIELD
TN200029382OtherRAILROAD MEDICARE
TN30106822Medicare PIN
TN0940098OtherUNITED HEALTH CARE
TN103I206084Medicare PIN
TN100021361OtherTENNCARE
TNTN0106OtherJOHN DEERE HEALTHCARE