Healthcare Provider Details

I. General information

NPI: 1487687133
Provider Name (Legal Business Name): JAMES N EICKHOLZ MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 NEW HOLT ROAD
PADUCAH KY
42001-7455
US

IV. Provider business mailing address

2425 NEW HOLT RD
PADUCAH KY
42001-7455
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4850
  • Fax: 270-441-4666
Mailing address:
  • Phone: 270-441-4850
  • Fax: 270-441-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32988
License Number StateKY

VIII. Authorized Official

Name: DR. JAMES NOAH EICKHOLZ
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 270-441-4850