Provider Demographics
NPI:1417524042
Name:HOLMES, VIRGIL LEE
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:LEE
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-4573
Mailing Address - Country:US
Mailing Address - Phone:731-221-1013
Mailing Address - Fax:731-221-3194
Practice Address - Street 1:373 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-4573
Practice Address - Country:US
Practice Address - Phone:731-221-1013
Practice Address - Fax:731-221-3194
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1310332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies