Healthcare Provider Details

I. General information

NPI: 1942256888
Provider Name (Legal Business Name): HOLZER HOSPITAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5051
  • Fax: 740-446-5522
Mailing address:
  • Phone: 740-446-5051
  • Fax: 740-446-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateOH

VIII. Authorized Official

Name: MICHAEL R CANADY
Title or Position: CEO
Credential: MD
Phone: 740-446-5051