Provider Demographics
NPI:1427444793
Name:GERIATRIC ASSESSMENT CENTER LLC
Entity type:Organization
Organization Name:GERIATRIC ASSESSMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRONICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-443-8226
Mailing Address - Street 1:40 CYPRESS CREEK PKWY
Mailing Address - Street 2:SUITE 143
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 CYPRESS CREEK PKWY
Practice Address - Street 2:SUITE 143
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3530
Practice Address - Country:US
Practice Address - Phone:281-443-8226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty