Provider Demographics
NPI:1578547790
Name:HOLCOMB, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0838
Mailing Address - Country:US
Mailing Address - Phone:913-469-4244
Mailing Address - Fax:913-469-1939
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-469-4244
Practice Address - Fax:913-469-1939
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS417246207P00000X
MOR7021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R7021Medicare UPIN
KS57771Medicare PIN
MON533952Medicare PIN
KS106174Medicare PIN
KS102974Medicare PIN
KSR863952BMedicare PIN
MOR863952Medicare PIN
KSJ673952Medicare PIN
MON773952Medicare PIN
MOR863952AMedicare PIN