Provider Demographics
NPI:1407045487
Name:HOLMES FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:HOLMES FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-676-0014
Mailing Address - Street 1:455 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4716
Mailing Address - Country:US
Mailing Address - Phone:863-676-0014
Mailing Address - Fax:863-676-0090
Practice Address - Street 1:455 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4716
Practice Address - Country:US
Practice Address - Phone:863-676-0014
Practice Address - Fax:863-676-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34977Medicare UPIN
FLK8529Medicare PIN