Provider Demographics
NPI:1881772804
Name:HENRY E HOLETS MD LLC
Entity type:Organization
Organization Name:HENRY E HOLETS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLETS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-258-7500
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-228-3418
Mailing Address - Fax:724-228-7040
Practice Address - Street 1:1290 CHESS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-258-7500
Practice Address - Fax:724-258-3618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
015926Medicare ID - Type Unspecified