Provider Demographics
NPI:1154514149
Name:HOLDAWAY MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:HOLDAWAY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-397-0525
Mailing Address - Street 1:2500 CONSTANT COMMENT PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6323
Mailing Address - Country:US
Mailing Address - Phone:800-397-0525
Mailing Address - Fax:502-266-9736
Practice Address - Street 1:475 METROPLEX DR
Practice Address - Street 2:SUITE 403
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3153
Practice Address - Country:US
Practice Address - Phone:615-331-6417
Practice Address - Fax:615-331-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00002688332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5941930004Medicare NSC