Organization
COUNTY OF PUTNAM OFFICE OF AUDITOR
Active
Parent organization
COUNTY OF PUTNAM OFFICE OF AUDITOR
Other names
Putnam County Palliative Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF PUTNAM OFFICE OF AUDITOR
Authorized official
DR. JACINTA EICKHOLT MD (MEDICAL DIRECTOR)
(419) 523-4449
Entity
Organization
Contact information
Practice address
575 OTTAWA GLANDORF RD STE 3, OTTAWA, OH 45875
(419) 523-4449
(419) 523-6328
Mailing address
PO BOX 312, OTTAWA, OH 45875-0312
(419) 523-4449
(419) 523-6328
Taxonomy
Speciality
Code
Description
License number
State
2081H0002X
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0311036
—
OH
Enumeration date
11/09/2017
Last updated
12/09/2020
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