Provider Demographics
NPI:1881785111
Name:JACK L. HOLLINS, M.D., P.S.C.
Entity type:Organization
Organization Name:JACK L. HOLLINS, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-264-7700
Mailing Address - Street 1:2353 ALEXANDRIA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3287
Mailing Address - Country:US
Mailing Address - Phone:859-264-7700
Mailing Address - Fax:859-264-7744
Practice Address - Street 1:2353 ALEXANDRIA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3287
Practice Address - Country:US
Practice Address - Phone:859-264-7700
Practice Address - Fax:859-264-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17380207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048591OtherANTHEM PROVIDER ID
KY180036565OtherRAILROAD MEDICARE ID
KY=========OtherTAX ID
KY000000048591OtherANTHEM PROVIDER ID
KY=========OtherTAX ID
KYA98211Medicare UPIN