Provider Demographics
NPI:1972854735
Name:CORPUS CHRISTI GERIMED SOLUTIONS CORP
Entity Type:Organization
Organization Name:CORPUS CHRISTI GERIMED SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-721-6431
Mailing Address - Street 1:4170 MANOR FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-8821
Mailing Address - Country:US
Mailing Address - Phone:561-721-6431
Mailing Address - Fax:561-721-6432
Practice Address - Street 1:801 NORTHPOINT PKWY
Practice Address - Street 2:SUITE 83
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1973
Practice Address - Country:US
Practice Address - Phone:561-721-6431
Practice Address - Fax:561-721-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 80513207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty