Provider Demographics
NPI:1356300420
Name:VANGUARD GERIATRICS INC
Entity Type:Organization
Organization Name:VANGUARD GERIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOSSEY SAX
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, GNP-BC
Authorized Official - Phone:713-521-0006
Mailing Address - Street 1:4660 BEECHNUT ST STE 218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1825
Mailing Address - Country:US
Mailing Address - Phone:713-521-0006
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST STE 218-A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1824
Practice Address - Country:US
Practice Address - Phone:713-521-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-18
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QG0300X
TX207QG0300X, 207R00000X, 207RG0300X, 208D00000X, 363LA2200X, 363LF0000X, 363LG0600X, 363LP2300X
TXG8285207QG0300X
TX637220363LF0000X
TX607064363LG0600X
TX425936363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012NLOtherBCBS TX
TX180881802Medicaid
TX177242801Medicaid
TXNP7230OtherBCBS
TX00W130Medicare PIN
TX612056Medicare PIN
TX177242801Medicaid