Provider Demographics
NPI:1962985010
Name:HOLLEY ANESTHESIA
Entity type:Organization
Organization Name:HOLLEY ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-207-4021
Mailing Address - Street 1:5424 WILLOW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2655
Mailing Address - Country:US
Mailing Address - Phone:214-207-4021
Mailing Address - Fax:469-791-9228
Practice Address - Street 1:5424 WILLOW WOOD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2655
Practice Address - Country:US
Practice Address - Phone:214-207-4021
Practice Address - Fax:469-791-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty