Basic Information
| Provider Information | |||||||||
| NPI: | 1841456399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATION SENIOR MEDICAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403449465 | ||||||||
| FaxNumber: | 7403443091 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403449465 | ||||||||
| FaxNumber: | 7403443091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7403449465 | ||||||||
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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 | 363LG0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.