Provider Demographics
NPI:1255380226
Name:GERICARE MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:GERICARE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-743-3844
Mailing Address - Street 1:521 WHETSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2615
Mailing Address - Country:US
Mailing Address - Phone:251-743-3844
Mailing Address - Fax:251-743-2495
Practice Address - Street 1:521 WHETSTONE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2615
Practice Address - Country:US
Practice Address - Phone:251-743-3844
Practice Address - Fax:251-743-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000054498Medicaid
15230B001OtherUNITED MINE WORKERS
AL51054498Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD
15230B001OtherUNITED MINE WORKERS