Provider Demographics
NPI:1124170808
Name:GERIATRIC AND HOSPICE MEDICAL SERVICES
Entity type:Organization
Organization Name:GERIATRIC AND HOSPICE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:281-358-7766
Mailing Address - Street 1:28 THE FLUME
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-1520
Mailing Address - Country:US
Mailing Address - Phone:281-358-7766
Mailing Address - Fax:281-605-1451
Practice Address - Street 1:28 THE FLUME
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-1520
Practice Address - Country:US
Practice Address - Phone:281-358-7766
Practice Address - Fax:281-605-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00486KMedicare ID - Type UnspecifiedMEDICARE GROUP