1639273121 NPI number — HOLISTIC SURGICAL ASSOCIATES, INC.

Table of content: (NPI 1639273121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639273121 NPI number — HOLISTIC SURGICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC SURGICAL ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BACK PAIN SOLUTIONS OF NORTHWEST OHIO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639273121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 W MARKET ST
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45801-4717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-331-2225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 W MARKET ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45801-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-331-2225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUCCHESE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
419-331-2225

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  203808853 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1346387123 . This is a "NP NPI" identifier . This identifiers is of the category "OTHER".




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