Provider Demographics
NPI:1669671087
Name:HOLEYFIELD HEALTH SYSTEMS PC
Entity Type:Organization
Organization Name:HOLEYFIELD HEALTH SYSTEMS PC
Other - Org Name:HOLEYFIELD CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLEYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-292-3987
Mailing Address - Street 1:10135 S 25TH ST
Mailing Address - Street 2:A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-292-3987
Mailing Address - Fax:402-292-4034
Practice Address - Street 1:10135 S 25TH ST
Practice Address - Street 2:A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-292-3987
Practice Address - Fax:402-292-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7463OtherBCBS
NE47063291413Medicaid
096355Medicare ID - Type Unspecified
NE47063291413Medicaid