Healthcare Provider Details

I. General information

NPI: 1629109780
Provider Name (Legal Business Name): HOLZER HOSPITAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTONSVILLE RD
JACKSON OH
45640-9452
US

IV. Provider business mailing address

280 PATTONSVILLE RD
JACKSON OH
45640-9452
US

V. Phone/Fax

Practice location:
  • Phone: 740-395-8870
  • Fax: 740-395-8897
Mailing address:
  • Phone: 740-395-8870
  • Fax: 740-395-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY B STOUT
Title or Position: CEO
Credential: MD
Phone: 404-465-5597