Provider Demographics
NPI:1699710285
Name:HOLLEY MEDICAL, INC.
Entity type:Organization
Organization Name:HOLLEY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-566-7963
Mailing Address - Street 1:513 S BRUNDIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3333
Mailing Address - Country:US
Mailing Address - Phone:334-566-7963
Mailing Address - Fax:334-566-0847
Practice Address - Street 1:513 S BRUNDIDGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3333
Practice Address - Country:US
Practice Address - Phone:334-566-7963
Practice Address - Fax:334-566-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL173332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL56774OtherBC/BS PROVIDER NUMBER
AL56774OtherBC/BS PROVIDER NUMBER