1255388294 NPI number — GEORGE GERO OD

Table of content: GEORGE GERO OD (NPI 1255388294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255388294 NPI number — GEORGE GERO OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERO
Provider First Name:
GEORGE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1255388294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E CENTURY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-0412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-222-1420
Provider Business Mailing Address Fax Number:
701-255-2414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E CENTURY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-0412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-222-1420
Provider Business Practice Location Address Fax Number:
701-255-2414
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  367 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60388 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: D001533 . This is a "CHAMPUS TRICA RE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12147 . This is a "ELGIN BCBS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800367 . This is a "ND VISION BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8883 . This is a "BCBS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60388 . This is a "ND SOCIAL SERVICE" identifier . This identifiers is of the category "OTHER".




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