1689816316 NPI number — GERIATRICS AND INTERNAL MEDICINE PRACTICES PA

Table of content: (NPI 1689816316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689816316 NPI number — GERIATRICS AND INTERNAL MEDICINE PRACTICES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRICS AND INTERNAL MEDICINE PRACTICES PA
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:
1689816316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 141045
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32614-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-367-9700
Provider Business Mailing Address Fax Number:
352-367-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3921 SW 34TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32608-6560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-336-3050
Provider Business Practice Location Address Fax Number:
352-337-2571
Provider Enumeration Date:
03/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZHU
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-367-9700

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  ME83771 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022ZJ . This is a "BC FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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