Active NPI
Holzer Hospital Foundation
- Specialty Pharmacy
- Gallipolis, OH
National Provider Identifier
1104581214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialty Pharmacy
- Legal business name
- HOLZER HOSPITAL FOUNDATION
- Practice address
- 448 Jackson Pike
Gallipolis, OH 45631-1324 - Phone
- (740) 446-5000
- NPI assigned
- Nov 3, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shana Booher
- Title
- Director of Credentialing
- Phone
- (740) 446-5551
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | |||
| Specialty Pharmacy | 3336S0011X | Primary |
Addresses
Primary practice location
448 Jackson Pike
Gallipolis, OH 45631-1324
Mailing address
448 Jackson Pike
Gallipolis, OH 45631-1324
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0232000280 | Other | OH | LICENSE TO DISTRIBUTE DANGEROUS DRUGS |
Other names 1
- Holzer Specialty Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220223000188 | OH | Part B Supplier - Pharmacy | 6901896927 | Practice locations: Gallipolis, OH |
| O20230501001593 | OH | DME Supplier - Pharmacy | 6901896927 | Practice locations: Gallipolis, OH |
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Community Based Hospice Care Agency
- Gallipolis, OH
- NPI 1194801860
6901896927
National Provider Directory
National Provider DirectoryLocations
448 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-2844
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635897600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1635897600000",
"number": "1104581214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 JACKSON PIKE",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "448 JACKSON PIKE",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311324",
"telephone_number": "740-446-5000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLZER HOSPITAL FOUNDATION",
"organizational_subpart": "NO",
"enumeration_date": "2021-11-03",
"last_updated": "2021-11-03",
"certification_date": "2021-11-03",
"status": "A",
"authorized_official_last_name": "BOOHER",
"authorized_official_first_name": "SHANA",
"authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
"authorized_official_telephone_number": "740-446-5551"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE TO DISTRIBUTE DANGEROUS DRUGS",
"identifier": "0232000280",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Holzer Specialty Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Gallipolis, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.