Charles Edward Holtz Jr., IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

1599 J St
Grand Forks Afb, ND 58205-6306

Phone

(701) 747-5504

Fax

(701) 747-5923

NPI assigned

May 13, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242172800000",
    "number": "1104050657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2026 SPRUCE DR",
            "address_2": "UNIT A",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582041864",
            "telephone_number": "701-747-5504",
            "fax_number": "701-747-5923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1599 J ST",
            "city": "GRAND FORKS AFB",
            "state": "ND",
            "postal_code": "582056306",
            "telephone_number": "701-747-5504",
            "fax_number": "701-747-5923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTZ",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_suffix": "Jr.",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard R Givens, M.D.
• Laine Maren Gordon, LCSW
• Cara Leigh Grausam
• Doreen Marie Hinsz, PHARM D
• Eve Marie Holton, PH.D.
• Debra Ann Kolden, RDH
• Timothy Kresien
• James T Kwasneski, LCSW
• Benjamin Lofgren, DPT
• Rebecca Leigh McLean, D.O.

• Independent Duty Medical Technicians in Grand Forks Afb, ND
• Providers in Grand Forks Afb, ND by specialty
• Independent Duty Medical Technicians in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.