Provider Demographics
NPI:1386914562
Name:WILLIAM C HOLLIDAY, MD, PS
Entity type:Organization
Organization Name:WILLIAM C HOLLIDAY, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PS
Authorized Official - Phone:425-869-1110
Mailing Address - Street 1:2300 130TH AVE NE
Mailing Address - Street 2:SUITE A 211
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1755
Mailing Address - Country:US
Mailing Address - Phone:425-869-1110
Mailing Address - Fax:425-869-9578
Practice Address - Street 1:2300 130TH AVE NE
Practice Address - Street 2:SUITE A 211
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1755
Practice Address - Country:US
Practice Address - Phone:425-869-1110
Practice Address - Fax:425-869-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00014845251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000102308Medicare UPIN