Provider Demographics
NPI:1407918279
Name:GERIATRIC PROVIDERS INC.
Entity Type:Organization
Organization Name:GERIATRIC PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDDHDEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-317-4949
Mailing Address - Street 1:6500 SHAWNEERIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243
Mailing Address - Country:US
Mailing Address - Phone:513-984-2300
Mailing Address - Fax:513-984-2353
Practice Address - Street 1:9200 MONTGOMERY ROAD
Practice Address - Street 2:SUITE 3A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243
Practice Address - Country:US
Practice Address - Phone:513-984-2300
Practice Address - Fax:513-984-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038994207R00000X
KY17701207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64863194OtherKENTUCKY MEDICAID
KY1896401OtherKENTUCKY MEDICARE
OH0302603Medicaid
OHCH9247781Medicare ID - Type UnspecifiedOHIO MEDICARE
C01450Medicare UPIN