1952350100 NPI number — GERIATRIC MEDICINE ASSOCIATES, PC

Table of content: (NPI 1952350100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952350100 NPI number — GERIATRIC MEDICINE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC MEDICINE ASSOCIATES, PC
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:
6
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:
1952350100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64180-0022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-643-1099
Provider Business Mailing Address Fax Number:
303-643-1176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11700 W 2ND PL
Provider Second Line Business Practice Location Address:
PLAZA II STE 450
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80228-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-825-1234
Provider Business Practice Location Address Fax Number:
303-321-8121
Provider Enumeration Date:
05/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAIN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-825-1234

Provider Taxonomy Codes

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

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

  • Identifier: CU0562 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 04005070 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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