Provider Demographics
NPI:1932177235
Name:HOLMES, YANCEY R (MD)
Entity Type:Individual
Prefix:
First Name:YANCEY
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-655-8910
Mailing Address - Fax:859-655-8911
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-8910
Practice Address - Fax:859-655-8911
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073095207RE0101X
IN01084814A207RE0101X
KY37247207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000567585OtherANTHEM BCBS
OH2317808Medicaid
OH2879621Medicaid
KY64051261Medicaid
OH9321441OtherOH MEDICARE GRP #
KY7100050890Medicaid
KY6293OtherKY MEDICARE GRP #
KY6293OtherKY MEDICARE GRP #
000000567585OtherANTHEM BCBS
OH9321441OtherOH MEDICARE GRP #
KY7100050890Medicaid
OH4167921Medicare PIN