Provider Demographics
NPI:1700860459
Name:GERIATRX CARE INC
Entity Type:Organization
Organization Name:GERIATRX CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-249-0528
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991-2569
Mailing Address - Country:US
Mailing Address - Phone:772-249-0528
Mailing Address - Fax:772-237-7841
Practice Address - Street 1:3756 SW BIMINI CIR S
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1335
Practice Address - Country:US
Practice Address - Phone:772-249-0528
Practice Address - Fax:772-237-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048468700Medicaid
FL07303OtherBLUE CROSS
FLK3512Medicare ID - Type Unspecified