Provider Demographics
NPI:1669410940
Name:HOLZER MEDICAL CENTER JACKSON
Entity type:Organization
Organization Name:HOLZER MEDICAL CENTER JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-446-5051
Mailing Address - Street 1:500 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9360
Mailing Address - Country:US
Mailing Address - Phone:740-395-8500
Mailing Address - Fax:740-395-8502
Practice Address - Street 1:500 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9360
Practice Address - Country:US
Practice Address - Phone:740-395-8500
Practice Address - Fax:740-395-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
OH282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224195Medicaid
OH361320Medicare Oscar/Certification