Provider Demographics
NPI:1316698509
Name:HOLISTIC ORIENTAL MEDICINE LLC
Entity type:Organization
Organization Name:HOLISTIC ORIENTAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DOAM
Authorized Official - Phone:757-812-8588
Mailing Address - Street 1:6017 BARKERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6838
Mailing Address - Country:US
Mailing Address - Phone:757-812-8588
Mailing Address - Fax:
Practice Address - Street 1:335 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6335
Practice Address - Country:US
Practice Address - Phone:757-812-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty