Provider Demographics
NPI:1629378310
Name:GERICARE CENTER LLC
Entity Type:Organization
Organization Name:GERICARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-666-0790
Mailing Address - Street 1:7539 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4350
Mailing Address - Country:US
Mailing Address - Phone:352-666-0790
Mailing Address - Fax:352-666-0903
Practice Address - Street 1:7539 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4350
Practice Address - Country:US
Practice Address - Phone:352-666-0790
Practice Address - Fax:352-666-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81127207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125028OtherHUMANA GOLD PLUS ID
FL5589903OtherFIRST HEALTH ID
FL7128124OtherAETNA ID
FLP004912OtherOPTIMUM ID
FL00780OtherUNIVERSAL ID
FL123192OtherHUMANA ID
FL279581700Medicaid
FLP04912OtherFREEDOM ID
FL1988649OtherUNITED HEALTHCARE ID
FL241506OtherWELLCARE ID
FL28922OtherAVMED ID
FL0153626OtherGHI ID
FL06055OtherBLUE CROSS BLUE SHIELD ID
FL7572308OtherCIGNA ID
FLME81127OtherMEDICAL LICENSE ID
FLME81127OtherMEDICAL LICENSE ID