Provider Demographics
NPI:1073082350
Name:GERIATRIC PRIMARY CARE PA
Entity type:Organization
Organization Name:GERIATRIC PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTIST
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:850-377-0925
Mailing Address - Street 1:12120 STATE LINE RD PMB 296
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-4368
Mailing Address - Country:US
Mailing Address - Phone:850-377-0925
Mailing Address - Fax:888-779-3217
Practice Address - Street 1:1500 W FOXWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9372
Practice Address - Country:US
Practice Address - Phone:850-377-0925
Practice Address - Fax:888-779-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty