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LISA MICHELLE HOLTSCLAW D.O. NPI 1619957164


NPI Information

NPI: 1619957164
Provider Name: LISA MICHELLE HOLTSCLAW, D.O.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Organization: OSH-IN PHYSICIANS GROUP PC

PECOS Registration: Yes

Address:
436 E WASHINGTON BLVD
FORT WAYNE, IN
ZIP 46802
Phone: (260) 209-7111
Get Directions

Lisa Michelle Holtsclaw, D.O. is a family medicine in Fort Wayne, IN with 31 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Lisa Michelle Holtsclaw, D.O. NPI is 1619957164. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Graduation Year:1993

The provider's business location address is:

436 E WASHINGTON BLVD
FORT WAYNE, IN
ZIP 46802-210
Phone: (260) 209-7111
Fax: (260) 222-2835

The NPI 1619957164 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/19/2006 and was last updated on 6/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine02001568AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100373060MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.