Provider Demographics
NPI:1881319325
Name:GERIATRIC ADVANCED PREVENTIVE SERVICES
Entity type:Organization
Organization Name:GERIATRIC ADVANCED PREVENTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-505-4277
Mailing Address - Street 1:8551 N 125TH EAST AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2160
Mailing Address - Country:US
Mailing Address - Phone:855-505-4277
Mailing Address - Fax:
Practice Address - Street 1:8551 N 125TH EAST AVE STE 250
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2160
Practice Address - Country:US
Practice Address - Phone:855-505-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical