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General NPI Number Information
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NPI Number | 1831602119
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Entity Type | Organization
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Legal Business Name | COUNTY OF PUTNAM OFFICE OF AUDITOR
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 575 OTTAWA GLANDORF RD STE 3
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City | OTTAWA
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State | OH
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Zip | 45875
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Country | US
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Telephone | 419-523-4449
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Fax | 419-523-6328
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | OTTAWA
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State | OH
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Zip | 45875-0312
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Country | US
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Telephone | 419-523-4449
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Fax | 419-523-6328
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JACINTA EICKHOLT
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Credential | MD
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Telephone | 419-523-4449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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