Provider Demographics
NPI:1104942515
Name:PAMELA Y. HOLLINS,M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:PAMELA Y. HOLLINS,M.D. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-267-6509
Mailing Address - Street 1:PO BOX 65077
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-5077
Mailing Address - Country:US
Mailing Address - Phone:225-267-6509
Mailing Address - Fax:225-267-6522
Practice Address - Street 1:4004 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3807
Practice Address - Country:US
Practice Address - Phone:225-267-6509
Practice Address - Fax:225-267-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04641R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312398Medicaid
LAB61514Medicare UPIN
LA5CX60Medicare PIN