Basic Information
| Provider Information | |||||||||
| NPI: | 1831177138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602658 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367163813 | ||||||||
| FaxNumber: | 3367165537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 200501857 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | 200501857 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 200501857 | NC | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3810004295 | 05 | WV | MEDICAID | 5260525 | 01 | AETNA | OTHER | 141NF | 01 | NC | BCBS | OTHER | 185802 | 01 | NC | MEDCOST | OTHER | 10230942 | 05 | VA | MEDICAID | 807306 | 01 | NC | PARTNERS | OTHER | Q01857 | 05 | SC | MEDICAID | 5902787 | 05 | NC | MEDICAID |