Provider Demographics
NPI:1215115910
Name:IM GERIATRICS GI LLC
Entity type:Organization
Organization Name:IM GERIATRICS GI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-328-1529
Mailing Address - Street 1:2330SW WILLISTON ROAD
Mailing Address - Street 2:SUITE 2616
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-328-1529
Mailing Address - Fax:352-548-4801
Practice Address - Street 1:2330 SW WILLISTON RD
Practice Address - Street 2:SUITE 2616
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4000
Practice Address - Country:US
Practice Address - Phone:352-328-1529
Practice Address - Fax:352-548-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000118073251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare