Provider Demographics
NPI:1982010690
Name:ACESO VISITING PHYSICIANS AND GERIATRIC CARE INC.
Entity Type:Organization
Organization Name:ACESO VISITING PHYSICIANS AND GERIATRIC CARE INC.
Other - Org Name:KRISTINE TEODORI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEODORI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-663-4888
Mailing Address - Street 1:300 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3281
Mailing Address - Country:US
Mailing Address - Phone:219-663-4877
Mailing Address - Fax:219-663-4877
Practice Address - Street 1:300 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3281
Practice Address - Country:US
Practice Address - Phone:219-663-4877
Practice Address - Fax:219-663-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002441207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400049314Medicare PIN