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General NPI Number Information
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NPI Number | 1588760383
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Entity Type | Organization
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Legal Business Name | PUTNAM COUNTY PRIMARY CARE LLC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1740 N PERRY ST SUITE A
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City | OTTAWA
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State | OH
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Zip | 45875-1173
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Country | US
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Telephone | 419-523-0012
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Fax | 419-523-3416
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Provider Business Mailing Address
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Address Line | PO BOX 450718
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City | WESTLAKE
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State | OH
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Zip | 44145-0614
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Country | US
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Telephone | 800-514-4390
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Fax | 440-808-3675
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY S EIDEN
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Credential | MD
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Telephone | 419-523-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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