Provider Demographics
NPI:1285779868
Name:HOLCOMB PEDIATRICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:HOLCOMB PEDIATRICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-681-3343
Mailing Address - Street 1:134 MENGER SPGS
Mailing Address - Street 2:1240
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7218
Mailing Address - Country:US
Mailing Address - Phone:830-816-5437
Mailing Address - Fax:830-331-9438
Practice Address - Street 1:134 MENGER SPGS
Practice Address - Street 2:1240
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7218
Practice Address - Country:US
Practice Address - Phone:830-816-5437
Practice Address - Fax:830-331-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6945208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports MedicineGroup - Multi-Specialty