Provider Demographics
NPI:1861807968
Name:RUBY L HOLLOWAY, M.D.P.A
Entity type:Organization
Organization Name:RUBY L HOLLOWAY, M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-7394
Mailing Address - Street 1:710 S 8TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4634
Mailing Address - Country:US
Mailing Address - Phone:409-832-7394
Mailing Address - Fax:409-832-7016
Practice Address - Street 1:710 S 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4634
Practice Address - Country:US
Practice Address - Phone:409-832-7394
Practice Address - Fax:409-832-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5180207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17043Medicare UPIN