Provider Demographics
NPI:1922065523
Name:AUSTIN, HOLLY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:BETH
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:BETH
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5808 W 110TH ST
Mailing Address - Street 2:ATTN: CMS URGENT CARE CENTER
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2504
Mailing Address - Country:US
Mailing Address - Phone:913-696-8228
Mailing Address - Fax:
Practice Address - Street 1:5808 W 110TH ST
Practice Address - Street 2:ATTN: CMS URGENT CARE CENTER
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-2504
Practice Address - Country:US
Practice Address - Phone:913-696-8228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100123770AMedicaid
2692843Medicare ID - Type Unspecified
E86853Medicare UPIN