| Holloway Group Inc | |
|
6613 N. Meridian Avenue Oklahoma City OK 73116 | |
| (405) 603-8450 | |
| (405) 603-8455 |
| Full Name | Holloway Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6613 N. Meridian Avenue, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Willis Holloway, Jr (OWNER/PRESIDENT) |
| Authorized Official Contact | 4056038450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holloway Group Inc 6400 Industrial Loop Greendale WI 53129-2452 Ph: (414) 423-4100 | Holloway Group Inc 6613 N. Meridian Avenue Oklahoma City OK 73116 Ph: (405) 603-8450 |
| NPI Number | 1497848147 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/17/2023 |
| Medicare PECOS PAC ID | 1951297985 |
|---|---|
| Medicare Enrollment ID | O20040225001056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497848147 | NPI | - | NPPES |
| 200036310A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Willis Holloway |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023054434 PECOS PAC ID: 9830085869 Enrollment ID: I20040225001083 |
| Provider Name | Sepideh Ahmadpour |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932452000 PECOS PAC ID: 2961643598 Enrollment ID: I20141204001772 |
| Provider Name | Stacey Waggoner- Fisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285008227 PECOS PAC ID: 0345544276 Enrollment ID: I20160212000775 |
| Provider Name | Imelda C Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437506680 PECOS PAC ID: 0941570725 Enrollment ID: I20170727000794 |
| Provider Name | Satera N Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902248123 PECOS PAC ID: 3072886324 Enrollment ID: I20170907002360 |
| Provider Name | Lindi Caylin Ciglar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558830968 PECOS PAC ID: 0446598015 Enrollment ID: I20190207000560 |
| Provider Name | Melissa Andrade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801339163 PECOS PAC ID: 1052785490 Enrollment ID: I20230324002706 |
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