Individual
KENNETH L HOLBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1559 SPARTA ST, MC MINNVILLE, TN 37110-1316
(931) 815-4000
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21847
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3045786
BLUE CROSS
TN
01
—
3051807
BLUE CROSS
TN
01
—
3062431
BLUE CROSS
TN
05
—
3073132
—
TN
05
—
3073134
—
TN
05
—
3333055
—
TN
01
—
37513
TLC TENNCARE
TN
01
—
5001148
TLC TENNCARE
TN
01
—
532950
OMNICARE TENNCARE
TN
01
—
P00259801
MEDICARE RAILROAD
TN
01
—
P00297030
MEDICARE RAILROAD
TN
Enumeration date
05/27/2006
Last updated
11/06/2007
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