Provider Demographics
NPI:1811170756
Name:GERIATRIC HEALTHCARE SERVICES OF GREATER CINCINNATI, LLC
Entity type:Organization
Organization Name:GERIATRIC HEALTHCARE SERVICES OF GREATER CINCINNATI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-372-0711
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0427
Mailing Address - Country:US
Mailing Address - Phone:513-569-6780
Mailing Address - Fax:859-372-0065
Practice Address - Street 1:2408 HILL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4732
Practice Address - Country:US
Practice Address - Phone:513-569-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDN8827OtherRR MEDICARE
OH2877785Medicaid
OH9374671Medicare PIN