1972509024 NPI number — COUNTY OF PUTNAM OFFICE OF AUDITOR

Table of content: (NPI 1972509024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972509024 NPI number — COUNTY OF PUTNAM OFFICE OF AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF PUTNAM OFFICE OF AUDITOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PUTNAM COUNTY HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972509024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTTAWA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45875-0312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-523-4449
Provider Business Mailing Address Fax Number:
419-523-6328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 O-G ROAD SUITE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-523-4449
Provider Business Practice Location Address Fax Number:
419-523-6328
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EICKHOLT
Authorized Official First Name:
JACINTA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
419-523-4449

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0109-HSP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0389511 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000233040 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".