NATHANIEL OVERTON HOLLOWAY M.D., NPI 1982659561 — CHICAGO (IL)

NPI 1982659561

13+ Years Experience Individual

NATHANIEL OVERTON HOLLOWAY M.D.

05/23/2006
PROVIDER ENUMERATION DATE
07/20/2009
LAST UPDATE DATE
1982659561
NPI NUMBER

About NATHANIEL OVERTON HOLLOWAY

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

NATHANIEL OVERTON HOLLOWAY is a provider established in CHICAGO, IL. The NPI number of NATHANIEL OVERTON HOLLOWAY is 1982659561 and was assigned on 05/23/2006. The practitioners primary taxonomy code is: 2085R0203X with license number: 36073542 IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606572827
  • Phone: 7739477850
  • Fax: 7739477852
  • Address: 3400 N LAKE SHORE DR
  • Address 2: UNIT 9-B

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1982659561
  • Phone : 7739477850
  • Fax : 7739477852
  • Postalcode : 606493954
  • Address : 7531 S STONY ISLAND AVE BASEMENT

Additional identifiers

  • Identifier: 36073542
  • Code / Type : 5 - MEDICAID
  • Identifier state : IL

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0203X
  • License number: 36073542
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • NATHANIEL OVERTON HOLLOWAY M.D.
  • Address : 7531 S STONY ISLAND AVE BASEMENT
  • Region : CHICAGO, IL
  • NPI : 1982659561
  • Phone : 7739477850
  • Fax : 7739477852
  • Postalcode : 606493954

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address7531 S STONY ISLAND AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressBASEMENT
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606493954
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7739477850
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7739477852
The fax number associated with the location address of the provider being identified.
NPI1982659561
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0203X
Provider Enumeration Date05/23/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07/20/2009
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)NATHANIEL OVERTON HOLLOWAY
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3400 N LAKE SHORE DR
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressUNIT 9-B
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606572827
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7739477850
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7739477852
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #12085R0203X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
Provider License Number 136073542
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 136073542
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IL
Other Provider Identifier State #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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