Provider Demographics
NPI:1720231483
Name:HOLZUM HEALTHCARE LLC
Entity Type:Organization
Organization Name:HOLZUM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-2580
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0125
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:2 PROGRESS POINT
Practice Address - Street 2:STE 101A
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2208
Practice Address - Country:US
Practice Address - Phone:636-236-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110686208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODO2172OtherRAILROAD MEDICARE
H30058Medicare UPIN
MOMA1399Medicare PIN