Holloway Group Inc
Organization Active NPI Multi-Specialty Clinic/Center · Oklahoma City, OK
NPI 1497848147 · NPPES record last updated Oct 17, 2023
Key facts
- NPI
- 1497848147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- HOLLOWAY GROUP INC
- Practice address
- 6613 N. Meridian Avenue
Oklahoma City, OK 73116 - Phone
- (405) 603-8450
- Fax
- (405) 603-8455
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Willis Holloway, Jr, M.D.
- Title
- Owner/President
- Phone
- (405) 603-8450
Practitioners 13
-
Jessye Sefenu Andoh, APRN/PMHNP
-
Melissa Andrade, APRN-CNP
-
Lindi Caylin Ciglar, APRN
-
Willis Holloway Jr., M.D.
-
Mujidat Seidu, DNP, APRN-CNP
-
Sepideh Ahmadpour, APNP-CNP
-
Stacey Alethea Waggoner, APRN-CNP
-
Satera Nicole Washington, APRN
-
Angela K Smith, PAC
-
Francis M Shelton, EDD,PSRS,CM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D1049173 | Holloway Group, the | Certificate of waiver | Dec 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040225001056 | OK | Part B Supplier - Clinic/Group Practice | 1951297985 |
Receives reassigned benefits from 9 practitioners Practice locations: Oklahoma City, OK; Midwest City, OK; Guthrie, OK |
National Provider Directory
Locations
4100 Newport Ave
Oklahoma City, OK 73112
Phone (405) 943-2273
605 NW 13th St
Oklahoma City, OK 73103
Phone (405) 239-7101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
6613 N. Meridian Avenue
Oklahoma City, OK 73116
Mailing address
6400 Industrial Loop
Greendale, WI 53129-2452
Phone (414) 423-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200036310A | Medicaid | OK |
Other providers in Oklahoma City, OK
- Ashley Adams Holloman
- Taylor Renee Holloman
- Emily Hollon
- Shana Hollopeter
- Grace Rose Holloran
- Allyson Cathryn Holloway
- Colbie Lenell Holloway
- Conley Holloway
- Daresha M Holloway
- Ellen Joan Holloway
All providers in Oklahoma City, OK · Multi-Specialty Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.