Healthcare Provider Details

I. General information

NPI: 1669410940
Provider Name (Legal Business Name): HOLZER MEDICAL CENTER JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BURLINGTON RD
JACKSON OH
45640-9360
US

IV. Provider business mailing address

500 BURLINGTON RD
JACKSON OH
45640-9360
US

V. Phone/Fax

Practice location:
  • Phone: 740-395-8500
  • Fax: 740-395-8502
Mailing address:
  • Phone: 740-395-8500
  • Fax: 740-395-8502

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 Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateOH

VIII. Authorized Official

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