Healthcare Provider Details

I. General information

NPI: 1639273121
Provider Name (Legal Business Name): HOLISTIC SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W MARKET ST SUITE 306
LIMA OH
45801-4717
US

IV. Provider business mailing address

545 W MARKET ST SUITE 306
LIMA OH
45801-4717
US

V. Phone/Fax

Practice location:
  • Phone: 419-331-2225
  • Fax:
Mailing address:
  • Phone: 419-331-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number203808853
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1346387123
Identifier TypeOTHER
Identifier State
Identifier IssuerNP NPI

VIII. Authorized Official

Name: CHRISTOPHER F LUCCHESE
Title or Position: MANAGING MEMBER
Credential: D.O.
Phone: 419-331-2225