Provider Demographics
NPI:1568525855
Name:HOLIFIELD CLINIC LLC
Entity Type:Organization
Organization Name:HOLIFIELD CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-289-2190
Mailing Address - Street 1:1100 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3310
Mailing Address - Country:US
Mailing Address - Phone:334-289-2190
Mailing Address - Fax:334-289-2195
Practice Address - Street 1:1100 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3310
Practice Address - Country:US
Practice Address - Phone:334-289-2190
Practice Address - Fax:334-289-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1436OtherPRESCRIPTIVE#
AL7780OtherAL LICENSE#
AL0308385OtherACOG#
AL1-045972OtherAL LICENSE#
AL85905-COWMedicaid
ALBH1672686OtherDEA#
ALP02152Medicare UPIN
AL85905-COWMedicaid
AL1-045972OtherAL LICENSE#