Provider Demographics
NPI:1427011808
Name:MILTON R. EICHMANN M.D., PSC
Entity Type:Organization
Organization Name:MILTON R. EICHMANN M.D., PSC
Other - Org Name:BLUFF UROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:EICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-686-7575
Mailing Address - Street 1:2530 LUCY LEE PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2436
Mailing Address - Country:US
Mailing Address - Phone:573-686-7575
Mailing Address - Fax:573-686-5199
Practice Address - Street 1:2530 LUCY LEE PKWY STE 1
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2436
Practice Address - Country:US
Practice Address - Phone:573-686-7575
Practice Address - Fax:573-686-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026717208800000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0774800001OtherDME NUMBER
MO506149400Medicaid
MO0774800001OtherDME NUMBER
MO0774800001Medicare NSC