Basic Information
| Provider Information | |||||||||
| NPI: | 1730248816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRIC ASSOCIATES OF ZANESVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3606 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404553304 | ||||||||
| FaxNumber: | 7404553686 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 CHINA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437311124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409826872 | ||||||||
| FaxNumber: | 7409825551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | CROWDER | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7404553304 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207RG0300X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0178249 | 05 | OH | MEDICAID |