Provider Demographics
NPI:1780023192
Name:HOLLAND SURGICAL GROUP
Entity Type:Organization
Organization Name:HOLLAND SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESCOTT
Authorized Official - Middle Name:BENTON
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-684-1578
Mailing Address - Street 1:PO BOX 532175
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053
Mailing Address - Country:US
Mailing Address - Phone:469-684-1578
Mailing Address - Fax:214-677-0079
Practice Address - Street 1:201 WEST TARRANT RD. #1420
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:469-684-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty