Provider Demographics
NPI:1194044792
Name:PROMONTORY GERIATRICS LLC
Entity Type:Organization
Organization Name:PROMONTORY GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-291-6667
Mailing Address - Street 1:214 W BELT LINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2430
Mailing Address - Country:US
Mailing Address - Phone:972-291-6667
Mailing Address - Fax:972-291-6672
Practice Address - Street 1:214 W BELT LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2430
Practice Address - Country:US
Practice Address - Phone:972-291-6667
Practice Address - Fax:972-291-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QH0002X, 207RG0300X
TXJ6337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty