Provider Demographics
NPI:1154863231
Name:RSS JON HOLMAN PLLC
Entity Type:Organization
Organization Name:RSS JON HOLMAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-469-3119
Mailing Address - Street 1:1050 TEXAN TRL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3741
Mailing Address - Country:US
Mailing Address - Phone:469-778-6100
Mailing Address - Fax:866-300-4682
Practice Address - Street 1:13301 N MERIDIAN AVE
Practice Address - Street 2:BLDG 100, SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9369
Practice Address - Country:US
Practice Address - Phone:405-486-7879
Practice Address - Fax:855-829-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42461223G0001X
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty