Provider Demographics
NPI:1154561025
Name:GEROPSYCH, PC
Entity type:Organization
Organization Name:GEROPSYCH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-649-4644
Mailing Address - Street 1:1220 S LIBERTY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-7513
Mailing Address - Country:US
Mailing Address - Phone:719-649-4644
Mailing Address - Fax:
Practice Address - Street 1:1601 CONSTITUTION RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2197
Practice Address - Country:US
Practice Address - Phone:719-562-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty