Provider Demographics
NPI:1215946660
Name:MARJORIE S HOLLAND
Entity type:Organization
Organization Name:MARJORIE S HOLLAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-728-4355
Mailing Address - Street 1:1718 LIVE OAK ST
Mailing Address - Street 2:BEAUFORT SQUARE
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1565
Mailing Address - Country:US
Mailing Address - Phone:252-728-4355
Mailing Address - Fax:252-728-4355
Practice Address - Street 1:1718 LIVE OAK ST
Practice Address - Street 2:BEAUFORT SQUARE
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1565
Practice Address - Country:US
Practice Address - Phone:252-728-4355
Practice Address - Fax:252-728-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID NUMBER
NC4267650001Medicare ID - Type UnspecifiedMEDICARE