Provider Demographics
NPI:1164067393
Name:GERIATRIC TELEMEDICINE AND ONCALL CONSULTANTS LLC.
Entity Type:Organization
Organization Name:GERIATRIC TELEMEDICINE AND ONCALL CONSULTANTS LLC.
Other - Org Name:GERIATRIC TELEMEDICINE AND ONCALL CONSULTANTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:806-441-6108
Mailing Address - Street 1:222 GENOA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1708
Mailing Address - Country:US
Mailing Address - Phone:806-441-6108
Mailing Address - Fax:
Practice Address - Street 1:222 GENOA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-1708
Practice Address - Country:US
Practice Address - Phone:806-441-6108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty