Healthcare Provider Details

I. General information

NPI: 1104581214
Provider Name (Legal Business Name): HOLZER HOSPITAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 JACKSON PIKE
GALLIPOLIS OH
45631-1324
US

IV. Provider business mailing address

448 JACKSON PIKE
GALLIPOLIS OH
45631-1324
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHANA BOOHER
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 740-446-5551