Provider Demographics
NPI:1164433959
Name:HOLT, ERIC (RESPIRATORY THERAPIS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:RESPIRATORY THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 KIA LEA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3278
Mailing Address - Country:US
Mailing Address - Phone:601-346-9423
Mailing Address - Fax:601-346-9423
Practice Address - Street 1:404 KIA LEA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3278
Practice Address - Country:US
Practice Address - Phone:601-346-9423
Practice Address - Fax:601-346-9423
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2278C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04381879Medicaid
MS5098160001Medicare NSC