Provider Demographics
NPI:1699955609
Name:WILLIAM H. OVERHOLSER, M.D., INC.
Entity type:Organization
Organization Name:WILLIAM H. OVERHOLSER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:OVERHOLSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-826-7621
Mailing Address - Street 1:1 E MAIN ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-1214
Mailing Address - Country:US
Mailing Address - Phone:740-826-7621
Mailing Address - Fax:740-826-1112
Practice Address - Street 1:1 E MAIN ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1214
Practice Address - Country:US
Practice Address - Phone:740-826-7621
Practice Address - Fax:740-826-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229756Medicaid
OHC00940Medicare UPIN
OHOV4023651Medicare PIN