Provider Demographics
NPI:1821459827
Name:GERIATRIC AND PALLIATIVE MEDICAL CARE OF TEXAS LLC
Entity Type:Organization
Organization Name:GERIATRIC AND PALLIATIVE MEDICAL CARE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TANPRASERTH
Authorized Official - Middle Name:
Authorized Official - Last Name:VATANADILOK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:210-379-7340
Mailing Address - Street 1:4879 CORIAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5599
Mailing Address - Country:US
Mailing Address - Phone:210-379-7340
Mailing Address - Fax:
Practice Address - Street 1:4879 CORIAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5599
Practice Address - Country:US
Practice Address - Phone:210-379-7340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty