Provider Demographics
NPI:1962403956
Name:ROLAND HOLLIS MD
Entity type:Organization
Organization Name:ROLAND HOLLIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:870-236-1014
Mailing Address - Street 1:400 HIGHWAY 49 N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4007
Mailing Address - Country:US
Mailing Address - Phone:870-236-1014
Mailing Address - Fax:870-236-9669
Practice Address - Street 1:400 HIGHWAY 49 N
Practice Address - Street 2:SUITE 2
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4007
Practice Address - Country:US
Practice Address - Phone:870-236-1014
Practice Address - Fax:870-236-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117653001Medicaid
AR53370Medicare PIN