Basic Information
| Provider Information | |||||||||
| NPI: | 1811170756 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERIATRIC HEALTHCARE SERVICES OF GREATER CINCINNATI, LLC | ||||||||
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| OtherOrganizationName: | GERIATRIC HEALTHCARE SERVICES, PLLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 427 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410220427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696780 | ||||||||
| FaxNumber: | 8593720065 | ||||||||
| Practice Location | |||||||||
| Address1: | 2408 HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450444732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUNS | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8593720711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 363AM0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | DN8827 | 01 | OH | RR MEDICARE | OTHER | 2877785 | 05 | OH | MEDICAID |