Basic Information
| Provider Information | |||||||||
| NPI: | 1245476134 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRICS CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636299 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138911006 | ||||||||
| FaxNumber: | 5137931032 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 OAK ST | ||||||||
| Address2: | STE 645 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696780 | ||||||||
| FaxNumber: | 5134690251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2008 | ||||||||
| LastUpdateDate: | 02/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | SRIVASTAVA | ||||||||
| AuthorizedOfficialFirstName: | MANISH | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5134697432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2958214 | 05 | OH | MEDICAID | DP7382 | 01 | RR MEDICARE | OTHER |