Provider Demographics
NPI:1427799535
Name:HOLM MEDICAL CLINIC INC
Entity type:Organization
Organization Name:HOLM MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-286-0200
Mailing Address - Street 1:2855 MILLER DRIVE, STE 205
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8093
Mailing Address - Country:US
Mailing Address - Phone:574-780-3312
Mailing Address - Fax:888-247-3121
Practice Address - Street 1:2855 MILLER DR STE 205
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8093
Practice Address - Country:US
Practice Address - Phone:574-286-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty