Provider Demographics
NPI:1891021523
Name:K HOLLOWAY INTERNATIONAL
Entity Type:Organization
Organization Name:K HOLLOWAY INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-999-0943
Mailing Address - Street 1:8753 VICEREGAL CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-5780
Mailing Address - Country:US
Mailing Address - Phone:704-999-0943
Mailing Address - Fax:
Practice Address - Street 1:8753 VICEREGAL CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-5780
Practice Address - Country:US
Practice Address - Phone:704-999-0943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10-0167296251X00000X, 332B00000X, 332BD1200X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251X00000XAgenciesSupports Brokerage
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No347E00000XTransportation ServicesTransportation Broker