Provider Demographics
NPI:1285789511
Name:GERICARES LLC
Entity type:Organization
Organization Name:GERICARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-666-0790
Mailing Address - Street 1:5344 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4562
Mailing Address - Country:US
Mailing Address - Phone:352-666-0790
Mailing Address - Fax:352-666-0903
Practice Address - Street 1:5344 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4562
Practice Address - Country:US
Practice Address - Phone:352-666-0790
Practice Address - Fax:352-666-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81127207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06055OtherBLUE CROSS BLUE SHIELD ID
FL352728686OtherTRICARE ID
FLME81127OtherMEDICAL LICENSE NUMBER
FL1988649OtherUNITED HEALTHCARE ID
FL5589903OtherFIRST HEALTH
FL123192OtherHUMANA ID
FL2795817 00Medicaid
FL28922OtherAVMED ID
FL125028OtherHUMANA GOLD PLUS ID
FL241506OtherWELLCARE ID
FL00780OtherUNIVERSAL ID
LA7572308OtherCIGNA ID
FL7128124OtherAETNA ID
FL06055OtherBLUE CROSS BLUE SHIELD ID
FLG78647Medicare UPIN