Provider Demographics
NPI:1922032960
Name:HOLDERMANN, INC
Entity Type:Organization
Organization Name:HOLDERMANN, INC
Other - Org Name:ACUTE FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:HOLDERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-779-5227
Mailing Address - Street 1:490 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8144
Mailing Address - Country:US
Mailing Address - Phone:541-779-5227
Mailing Address - Fax:541-779-1938
Practice Address - Street 1:490 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8144
Practice Address - Country:US
Practice Address - Phone:541-779-5227
Practice Address - Fax:541-779-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00350213E00000X
ORDP00351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213610Medicaid
OR213610Medicaid
ORR117313Medicare PIN
OR5053260001Medicare PIN