Provider Demographics
NPI:1760827141
Name:HOLTER LABS, INC
Entity Type:Organization
Organization Name:HOLTER LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-821-4667
Mailing Address - Street 1:PO BOX 25408
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0408
Mailing Address - Country:US
Mailing Address - Phone:888-821-4667
Mailing Address - Fax:888-821-4677
Practice Address - Street 1:684 W SHILOH UNITY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6803
Practice Address - Country:US
Practice Address - Phone:888-821-4667
Practice Address - Fax:888-821-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00089823291U00000X
CA00059578291U00000X
SC00089823291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory