Basic Information
| Provider Information | |||||||||
| NPI: | 1366596744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE GERAD CENTER FOR CANCER TREATMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 W MARKET ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192223737 | ||||||||
| FaxNumber: | 4192293234 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 W MARKET ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192223737 | ||||||||
| FaxNumber: | 4192293234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | GERAD | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4192223737 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2301404 | 05 | OH | MEDICAID | 2301440 | 05 | OH | MEDICAID | 2501760 | 05 | OH | MEDICAID | 2301397 | 05 | OH | MEDICAID | 2301413 | 05 | OH | MEDICAID |