Provider Demographics
NPI:1992267736
Name:HOLLAND OATES LLC
Entity type:Organization
Organization Name:HOLLAND OATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:260-222-4996
Mailing Address - Street 1:982 KOEHLINGER DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1712
Mailing Address - Country:US
Mailing Address - Phone:260-749-1940
Mailing Address - Fax:260-749-2791
Practice Address - Street 1:982 KOEHLINGER DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1712
Practice Address - Country:US
Practice Address - Phone:260-749-1940
Practice Address - Fax:260-749-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental