Provider Demographics
NPI:1417340654
Name:NATURE COAST GERIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:NATURE COAST GERIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-746-0041
Mailing Address - Street 1:3404 N LECANTO HWY STE C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3569
Mailing Address - Country:US
Mailing Address - Phone:352-746-1558
Mailing Address - Fax:352-746-3838
Practice Address - Street 1:3404 N LECANTO HWY STE C
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3569
Practice Address - Country:US
Practice Address - Phone:352-746-1558
Practice Address - Fax:352-746-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty