Provider Demographics
NPI:1215774674
Name:EICHOLTZ, SCOTT I
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:EICHOLTZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15401 WILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-3455
Mailing Address - Country:US
Mailing Address - Phone:804-787-3439
Mailing Address - Fax:
Practice Address - Street 1:15401 WILLMAN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3455
Practice Address - Country:US
Practice Address - Phone:804-787-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty