PATRICK M. HOLLY (NPI# 1811933583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811933583 |
| Entity Type | Individual |
| Full Name | PATRICK M. HOLLY |
| Credential | MD |
| Practice Address |
6404 Rothman Rd Fort Wayne IN 46835-1366 |
| Mailing Address |
6920 Pointe Inverness Way Ste 200 Fort Wayne IN 46804-7934 |
| Practice Telephone | 2604866197 |
| Practice Fax Number | 2604869862 |
| Mailing Telephone | 2604793516 |
| Mailing Fax Number | 2604793520 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-10-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 01042777A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200009260 | 05 | |
| BLUE CROSS | 000000206199 | 01 |
| Street Address |
6404 ROTHMAN RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46835-1366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538480439 | Keith J. Derickson | Family Medicine | 6404 Rothman Rd, Fort Wayne, IN 46835-1366 | 2010-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760993810 | Longe Enterprises Corp | Eyewear Supplier (Equipment, not the service) | 5711 Ymca Park Dr East, Fort Wayne, IN 46835 | 2017-10-17 |
| 1801144464 | Tracey Gordon | Physical Therapy Assistant | 2827 Northgate Boulevard, Fort Wayne, IN 46835 | 2012-08-29 |
| 1316179682 | Janet L Daniel | Counselor | 310 E Dupont Road, Suite 2, Fort Wayne, IN 46835 | 2009-08-20 |
| 1083868863 | Nicholas Joseph Sullivan | Chiropractor | 8320 Chapel Bend Drive, Fort Wayne, IN 46835 | 2008-11-06 |
| 1497922090 | Michelle A Bailey | Registered Nurse | 6108 Maplecrest Road, Fort Wayne, IN 46835 | 2008-05-13 |
| 1073789954 | Charles Arthur Bolinger | Technician, Other | 4546 Maplecrest Rd, Ft Wayne, IN 46835 | 2008-05-01 |
| 1851469878 | Richard J Klaehn | Optometrist | 4536 Maplecrest Road, Ft. Wayne, IN 46835 | 2006-11-30 |
| 1639272339 | Hook Superx LLC | Durable Medical Equipment & Medical Supplies | 6220 St Joseph Center Rd, Fort Wayne, IN 46835 | 2006-09-07 |
| 1275649014 | Adrienne Meyer | Pharmacist | 7909 Brixham Place, Fort Wayne, IN 46835 | 2006-08-22 |
| 1750378147 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 4430 Elsdale Dr, Fort Wayne, IN 46835 | 2005-09-30 |
| Find all providers in zip 46835 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760912026 | Christina A Tatara | Family Medicine | 6511 E State Blvd, Fort Wayne, IN 46815-7026 | 2017-06-19 |
| 1700317633 | Robert Campbell | Family Medicine | 7411 Hope Dr, Fort Wayne, IN 46815-5687 | 2017-03-22 |
| 1487196424 | American Vein Institute LLC | Family Medicine | 10020 Dupont Circle Ct Ste 140, Fort Wayne, IN 46825-1621 | 2016-11-08 |
| 1831547124 | Anna Menze | Family Medicine | 10307 Dupont Circle Dr W Ste A, Fort Wayne, IN 46825-1633 | 2016-05-27 |
| 1407203672 | Credo Health Group, LLC | Family Medicine | 10228 Dupont Circle Dr E # 100b, Fort Wayne, IN 46825-1611 | 2016-05-18 |
| 1649625104 | Gabrielle Paloma Acquaro | Family Medicine | 7806 W Jefferson Blvd Ste E, Fort Wayne, IN 46804-4180 | 2016-05-03 |
| 1720491731 | John E Marx | Family Medicine | 1007 W Rudisill Blvd, Fort Wayne, IN 46807-2170 | 2014-06-06 |
| 1457763252 | Amy Simpson | Family Medicine | 1818 Carew St Ste 120, Fort Wayne, IN 46805-4764 | 2014-05-28 |
| 1932536083 | Clifford James Shultz | Family Medicine | 2616 Covington Pointe Trl, Fort Wayne, IN 46804-2773 | 2013-10-03 |
| 1164860086 | Andrew J Mullally | Family Medicine | 10050 Auburn Park Dr, Fort Wayne, IN 46825-2389 | 2013-06-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46835 |
Please comment or provide details below to improve the information on PATRICK M. HOLLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.