Provider Demographics
NPI:1801968524
Name:WILLIAM R HOLMES, DO
Entity type:Organization
Organization Name:WILLIAM R HOLMES, DO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-535-1484
Mailing Address - Street 1:310 WENDELL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-1480
Mailing Address - Fax:406-535-1481
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-1480
Practice Address - Fax:406-535-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG4190OtherRAILROAD MEDICARE
MT0654730001Medicare NSC