Provider Demographics
NPI:1740613025
Name:MARY T HOLCOMB LLC
Entity Type:Organization
Organization Name:MARY T HOLCOMB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-951-6920
Mailing Address - Street 1:125 W PINEVIEW ST
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2007
Mailing Address - Country:US
Mailing Address - Phone:407-951-6920
Mailing Address - Fax:407-951-6923
Practice Address - Street 1:125 W PINEVIEW ST
Practice Address - Street 2:SUITE 1005
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2007
Practice Address - Country:US
Practice Address - Phone:407-951-6920
Practice Address - Fax:407-951-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health