Provider Demographics
NPI:1316140577
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:502-266-0092
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:502-266-0092
Mailing Address - Fax:502-266-9736
Practice Address - Street 1:5333 COMMERCE SQUARE DR
Practice Address - Street 2:SUITE K
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8627
Practice Address - Country:US
Practice Address - Phone:317-882-4467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5941930003Medicare NSC