Provider Demographics
NPI:1063457562
Name:GERIATRIC HEALTHCARE SERVICES, P.C.
Entity Type:Organization
Organization Name:GERIATRIC HEALTHCARE SERVICES, P.C.
Other - Org Name:MARIA EUGENIA IRUELA, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-245-2764
Mailing Address - Street 1:PO BOX 24416
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4416
Mailing Address - Country:US
Mailing Address - Phone:336-245-2764
Mailing Address - Fax:336-923-2189
Practice Address - Street 1:4016 HUNTSCROFT LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4777
Practice Address - Country:US
Practice Address - Phone:336-245-2764
Practice Address - Fax:336-245-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901KAMedicaid
NC012KAOtherBCBSNC
NCCH6935OtherRAIL ROAD MEDICARE
NC8901KAMedicaid