Provider Demographics
NPI:1487687133
Name:JAMES N EICKHOLZ MD PSC
Entity Type:Organization
Organization Name:JAMES N EICKHOLZ MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:EICKHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-441-4850
Mailing Address - Street 1:2425 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7455
Mailing Address - Country:US
Mailing Address - Phone:270-441-4850
Mailing Address - Fax:270-441-4666
Practice Address - Street 1:2425 NEW HOLT ROAD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7455
Practice Address - Country:US
Practice Address - Phone:270-441-4850
Practice Address - Fax:270-441-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053971OtherBCBS
KY000000061801OtherBCBS/ANTHEM