Provider Demographics
NPI:1699803445
Name:HOLISTIC SURGICAL ASSOC. INC.
Entity type:Organization
Organization Name:HOLISTIC SURGICAL ASSOC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUCCHESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACOS
Authorized Official - Phone:419-228-8012
Mailing Address - Street 1:770 W HIGH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3990
Mailing Address - Country:US
Mailing Address - Phone:419-228-8012
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-228-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6268010002OtherMEDICARE DME
6268010002OtherMEDICARE DME
NP28412Medicare UPIN
LU0837462Medicare PIN
G23167Medicare UPIN
6268010002Medicare NSC
H09318291Medicare PIN