# RANDALL STREET MEDICAL PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598734584
- **Authorized official:** DR. ROGER HOLMAN D.O. (OWNER/PHYSICIAN)
- **Authorized official phone:** (616) 837-9777

## Contact information

- **Practice address:** 675 W RANDALL ST, COOPERSVILLE, MI 49404-1305
- **Practice address phone:** (616) 837-9777
- **Practice address fax:** (616) 837-7813
- **Mailing address:** 675 W RANDALL ST, COOPERSVILLE, MI 49404-1305
- **Mailing address phone:** (616) 837-9777
- **Mailing address fax:** (616) 837-7813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 5101006733 | MI | Yes |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 07/22/2008