=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477981991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER E HOLBROOK SR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2013
-----------------------------------------------------
Last Update Date | 10/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 COON HOLLOW RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-259-0808
-----------------------------------------------------
Fax | 740-259-4095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1630 COON HOLLOW RD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648-8872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-259-0808
-----------------------------------------------------
Fax | 740-259-4095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CHRISTOPHER E HOLBROOK SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-259-0808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | HMEL11495
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------