1780647560 NPI number — ERIC VICTOR JELINGER MD

Table of content: KRISTIN LEAH BARRETT M.D. (NPI 1497287643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780647560 NPI number — ERIC VICTOR JELINGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JELINGER
Provider First Name:
ERIC
Provider Middle Name:
VICTOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1780647560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 S WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN WERT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45891-2551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-232-5279
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 TIQUA TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-999-5353
Provider Business Practice Location Address Fax Number:
866-898-2159
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35061496 , 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: 000000028205 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0855632 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: JE0717158 . This is a "MEDICARE ID FSH RAD GRP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: JE0717158 . This is a "MEDICARE OHIO ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 300071733 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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