Provider Demographics
NPI:1225208200
Name:GERIATRIC EVALUATION & MENTAL
Entity Type:Organization
Organization Name:GERIATRIC EVALUATION & MENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSTENHABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-301-7200
Mailing Address - Street 1:12012 WICKCHESTER LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1229
Mailing Address - Country:US
Mailing Address - Phone:832-448-2800
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:4501 DUDMAR DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6913
Practice Address - Country:US
Practice Address - Phone:832-448-2800
Practice Address - Fax:832-448-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCJ2516OtherRAILROAD MEDICARE
TX00632RMedicare PIN