Provider Demographics
NPI:1396863098
Name:HOLDERMAN O2
Entity Type:Organization
Organization Name:HOLDERMAN O2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-466-2234
Mailing Address - Street 1:119 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1524
Mailing Address - Country:US
Mailing Address - Phone:814-466-2234
Mailing Address - Fax:
Practice Address - Street 1:119 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1524
Practice Address - Country:US
Practice Address - Phone:814-466-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA81161042332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHO243990OtherBLUE SHIELD
PA01742003Medicaid
PAHO243990OtherBLUE SHIELD