Provider Demographics
NPI:1336217439
Name:HOLLOWAY RURAL MEDICAL CLINIC LLC.
Entity Type:Organization
Organization Name:HOLLOWAY RURAL MEDICAL CLINIC LLC.
Other - Org Name:HOLLOWAY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:318-466-1410
Mailing Address - Street 1:10115 HIGHWAY 28 E
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-0746
Mailing Address - Country:US
Mailing Address - Phone:318-466-1410
Mailing Address - Fax:318-466-1409
Practice Address - Street 1:10115 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-0746
Practice Address - Country:US
Practice Address - Phone:318-466-1410
Practice Address - Fax:318-466-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1110876Medicaid
LA1110876Medicaid