Provider Demographics
NPI:1922277854
Name:DAMON S LITSEY
Entity Type:Organization
Organization Name:DAMON S LITSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLDERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-0338
Mailing Address - Street 1:1567 CASSINGHAM HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9432
Mailing Address - Country:US
Mailing Address - Phone:740-622-0338
Mailing Address - Fax:
Practice Address - Street 1:1567 CASSINGHAM HOLLOW DR
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-9432
Practice Address - Country:US
Practice Address - Phone:740-622-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2656332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4385660001Medicare NSC