Provider Demographics
NPI:1154727014
Name:JEROME HOLMES
Entity type:Organization
Organization Name:JEROME HOLMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:918-743-4768
Mailing Address - Street 1:3855 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3045
Mailing Address - Country:US
Mailing Address - Phone:918-743-4768
Mailing Address - Fax:
Practice Address - Street 1:3855 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3045
Practice Address - Country:US
Practice Address - Phone:918-743-4768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management