Basic Information
| Provider Information | |||||||||
| NPI: | 1063423929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLZKNECHT | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 422 HAMILTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245925200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345724074 | ||||||||
| FaxNumber: | 4345724712 | ||||||||
| Practice Location | |||||||||
| Address1: | 422 HAMILTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245925200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345724074 | ||||||||
| FaxNumber: | 4345724712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101244982 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | L3343 | 01 | TX | MEDICAL LICENSE | OTHER | P00045079 | 01 | TX | MEDICARE RR | OTHER | 148526001 | 05 | TX | MEDICAID | 0076948 | 01 | TX | BLUE LINK | OTHER | 8F4790 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |