Provider Demographics
NPI:1265603591
Name:GERIMED 2000 LLC
Entity type:Organization
Organization Name:GERIMED 2000 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-918-5000
Mailing Address - Street 1:5330 EHRLICH ROAD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6975
Mailing Address - Country:US
Mailing Address - Phone:803-908-5000
Mailing Address - Fax:813-908-5030
Practice Address - Street 1:5330 EHRLICH ROAD
Practice Address - Street 2:SUITE 138
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6975
Practice Address - Country:US
Practice Address - Phone:803-908-5000
Practice Address - Fax:813-908-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061377207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124022546OtherOSCAR NPI
FLME0061377OtherOSCAR M.D. LICENSE
FL265467900Medicaid
F14773Medicare UPIN
14536VMedicare Oscar/Certification