Provider Demographics
NPI:1447000989
Name:HOLCOMB, MIKE
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 N ROCKBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1139
Mailing Address - Country:US
Mailing Address - Phone:540-836-1120
Mailing Address - Fax:
Practice Address - Street 1:1114 N ROCKBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1139
Practice Address - Country:US
Practice Address - Phone:540-836-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist