Provider Demographics
NPI:1376825554
Name:MEHAN GERIATRIC CARE CORP
Entity Type:Organization
Organization Name:MEHAN GERIATRIC CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-558-4549
Mailing Address - Street 1:8737 BALLY BUNION RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3086
Mailing Address - Country:US
Mailing Address - Phone:954-558-4549
Mailing Address - Fax:
Practice Address - Street 1:8737 BALLY BUNION RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3086
Practice Address - Country:US
Practice Address - Phone:954-558-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty