Provider Demographics
NPI:1689897142
Name:MEDICAL EDUCATION AND GERIATRICS PLLC
Entity Type:Organization
Organization Name:MEDICAL EDUCATION AND GERIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAHM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-546-9158
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:5215 LINDEN CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2143
Practice Address - Country:US
Practice Address - Phone:303-869-2162
Practice Address - Fax:303-869-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD88960Medicare UPIN
COC451998Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER