1245476134 NPI number — GERIATRICS CONSULTANTS, LLC

Table of content: (NPI 1245476134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245476134 NPI number — GERIATRICS CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRICS CONSULTANTS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245476134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-607-7283
Provider Business Mailing Address Fax Number:
513-793-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 OAK ST
Provider Second Line Business Practice Location Address:
STE 645
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45206-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-607-7283
Provider Business Practice Location Address Fax Number:
513-469-0251
Provider Enumeration Date:
12/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SRIVASTAVA
Authorized Official First Name:
MANISH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-607-7283

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2958214 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP7382 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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