Holliway Medical Clinic LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

021100 Issued in LA

Legal business name

HOLLIWAY MEDICAL CLINIC LLC

Practice address

3824 Hearne Ave
Shreveport, LA 71103

Phone

(318) 635-8606

Fax

(318) 635-1265

NPI assigned

Feb 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brondwyn Ann Holliway, MDNPI 1790818359

Title

Physician

Phone

(318) 635-8606

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Holliway Pediatric Clinic Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brondwyn Holliway, M.D.

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1790818359
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891833869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-635-8606",
            "fax_number": "318-635-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3824 HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-635-8606",
            "fax_number": "318-635-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLIWAY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLIWAY",
        "authorized_official_first_name": "BRONDWYN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "318-635-8606",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "021100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1966207",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP #",
            "identifier": "1449423",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holliway Pediatric Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Deborah Susan Hollis, PA-C
• Joshua Hollis, M.A.
• Keriann Hollis, PLPC
• Sheila Hollis
• Anne M Hollister, M.D.
• Brondwyn Holliway, M.D.
• Linda Holloway, CCC-SLP
• Matthew Braxton Hollowell, RT(R)
• Holly D. Casey, MD, a Professional Medical Corp
• Holly D. Casey, MD. a Professional Medical Corp.

• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.