NPIMap

Organization Active NPI

Holzer Hospital Foundation

Doing business as Holzer Family Pharmacy Jackson

  • Community/Retail Pharmacy
  • Jackson, OH
National Provider Identifier
1629109780
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HOLZER HOSPITAL FOUNDATION
Doing business as
Holzer Family Pharmacy Jackson
Practice address
280 Pattonsville Rd
Jackson, OH 45640-9452
Phone
(740) 395-8870
Fax
(740) 395-8897
NPI assigned
Mar 8, 2007
Last updated
Sep 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Mr. Rodney B Stout, MD
Title
Ceo
Phone
(404) 465-5597

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

280 Pattonsville Rd
Jackson, OH 45640-9452

Mailing address

280 Pattonsville Rd
Jackson, OH 45640-9452
Phone (740) 395-8870

Other identifiers 1

IdentifierTypeStateIssuer
2163144MedicaidOH

Other names 1

  • Holzer Family Pharmacy Jackson Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251031000390 OH Part B Supplier - Mass Immunization (Roster Biller Only) 6901896927 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, OH; Gallipolis, OH; Athens, OH

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Holzer Medical Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

170 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5129

248 Jackson Pike
Gallipolis, OH 45631
Phone (740) 446-5700

280 Pattonsville Rd
Jackson, OH 45640
Phone (740) 395-8805

88 E Memorial Dr
Pomeroy, OH 45769
Phone (740) 992-0060

98 State St
Proctorville, OH 45669
Phone (740) 886-9403

2605 Jackson Ave
Pt Pleasant, WV 25550
Phone (304) 675-4498

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1629109780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 PATTONSVILLE RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409452",
            "telephone_number": "740-395-8870",
            "fax_number": "740-395-8897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 PATTONSVILLE RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409452",
            "telephone_number": "740-395-8870",
            "fax_number": "740-395-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLZER HOSPITAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-465-5597",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2163144",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holzer Family Pharmacy Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; 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.

Verify at the official NPI Registry.