Provider Demographics
NPI:1356500805
Name:EICKHOLT, JACINTA CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:CATHERINE
Last Name:EICKHOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACINTA
Other - Middle Name:CATHERINE
Other - Last Name:BORGELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:3224 JARVIS RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2213
Practice Address - Country:US
Practice Address - Phone:419-996-5757
Practice Address - Fax:419-996-5913
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014499A207Q00000X
390200000X
OH35.099945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074054Medicaid
OHH134630Medicare PIN