Provider Demographics
NPI:1578681888
Name:GEORGES HEALTHCARE CENTER
Entity Type:Organization
Organization Name:GEORGES HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GEORGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-671-0850
Mailing Address - Street 1:3801 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SHADYSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:43947-1320
Mailing Address - Country:US
Mailing Address - Phone:740-671-0850
Mailing Address - Fax:740-671-0848
Practice Address - Street 1:3801 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SHADYSIDE
Practice Address - State:OH
Practice Address - Zip Code:43947-1320
Practice Address - Country:US
Practice Address - Phone:740-671-0850
Practice Address - Fax:740-671-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0805614Medicaid
GE0617784Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
OH0805614Medicaid
9354401Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER