Provider Demographics
NPI:1750167326
Name:ANDEAN GERIATRIC SERVICES LLC
Entity type:Organization
Organization Name:ANDEAN GERIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-262-1212
Mailing Address - Street 1:13770 58TH ST N STE 308
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3759
Mailing Address - Country:US
Mailing Address - Phone:727-262-1212
Mailing Address - Fax:727-324-6902
Practice Address - Street 1:13770 58TH ST N STE 308
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3759
Practice Address - Country:US
Practice Address - Phone:727-262-1212
Practice Address - Fax:727-324-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care