MEDICARE: EYONG&ETTA HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1558126227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYONG&ETTA HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 361597
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43236-1597
Country	:	US
Telephone Number	:	240-758-2263
Fax Number	:	124-084-7906

Provider Business Practice Location Address
First Line	:	5397 RAVINE BLUFF CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-3156
Country	:	US
Telephone Number	:	240-758-2263
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADOLF OBEN
Credential	:
Telephone Number	:	240-758-2263

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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Directions to “EYONG&ETTA HEALTHCARE ” Practice Location

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