Basic Information
| Provider Information | |||||||||
| NPI: | 1780647560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JELINGER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | VAN WERT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458912551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192325279 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 TIQUA TRAIL | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458054705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199995353 | ||||||||
| FaxNumber: | 8668982159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35061496 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000028205 | 01 | OH | ANTHEM | OTHER | 0855632 | 05 | OH | MEDICAID | JE0717158 | 01 | OH | MEDICARE ID FSH RAD GRP | OTHER | JE0717158 | 01 | OH | MEDICARE OHIO ID | OTHER | 300071733 | 01 | OH | RAILROAD MEDICARE | OTHER |